By KR Sudhaman, Dec 6, 2011, Source
A MERE additional spending of 0.25 per cent of India’s GDP over the next 20 years is enough to provide drinking water, sanitation and sewage to all 8,000-plus towns and cities in the country. India’s GDP is presently surging towards $2 trillion mark.
This is what is claimed by Aromar Revi, the director of the newly set up Indian Institute of Human Settlements, a non-profit making Bangalore-based organisation promoted, among others, by Nandan Nilekani, Deepak Parikh, Jamshyed Godrej, Keshuv Mahindra, Kishore Mariwala, Vijay Kelkar and Rakesh Mohan.
By 2030 two-thirds of India’s population will be living in urban areas. They will need infrastructure. Finding the money required – as assessed by the institute – to set up infrastructure is not difficult, says Revi. It is the cost that goes into one or two metro transport projects.
In per capita terms, India’s annual capital spending on urban infrastructure, including road and transport, is just $17, which only 14 per cent of China’s $116 and under 6 per cent of New York’s $292. New research by the McKinsey Global Institute released a few months ago has said that urban India needs to spend $134 per capita per year till 2030 — almost eight times what it invests now.
Current Opinion in Environmental Sustainability, Nov 2011
Global change, wastewater and health in fast growing economies
Saravanan VS1, Peter P Mollinga2, Janos J Bogardi3,
1-Center for Development Research (ZEF), University of Bonn, Walter Flex Strasse 3, Bonn 53113, Germany
2-SOAS, University of London, Thornhaugh Street, Russell Square, London WC1H 0XG, United Kingdom
3-Global Water Systems Project (GWSP), Walter Flex Strasse 3, Bonn 53113, Germany
It is well known that water and sanitation are important to address major water-related diseases. Less known is the impact of continuous exposure to poor water quality on human health in fast growing economies comprising about half of the world’s population. Crucial questions persist — Does the economic success of emerging countries translate into improved water management and better human health, or pose additional risks? How does population growth, development of agriculture, industrialisation and urbanisation affect human health in poverty-stricken and undernourished regions?
Though science has contributed significantly in addressing the threat from water-related diseases, solutions to these complex problems are still sought in a simple, one-dimensional ‘cause-effect remedy’ context. This paper calls for scientific and policy initiatives to move beyond this stage to understand the complex links between water and health. In addition, it urges the international community to establish a scientific monitoring and research platform to spearhead the efforts and spread information on improving water quality and human health.
J Health Popul Nutr. 2011 April; 29(2): 123–133.
Healthcare-use for Major Infectious Disease Syndromes in an Informal Settlement in Nairobi, Kenya
Robert F. Breiman, Beatrice Olack, Alvin Shultz, Sanam Roder, Kabuiya Kimani, Daniel R. Feikin, and Heather Burke
International Emerging Infections Program CDC-Kenya Medical Research Institute, Nairobi, Kenya
Correspondence and reprint requests should be addressed to: Dr. Robert F. Breiman, Kenya Medical Research Institute-CDC, Email: rbreiman@ke.cdc.gov
A healthcare-use survey was conducted in the Kibera informal settlement in Nairobi, Kenya, in July 2005 to inform subsequent surveillance in the site for infectious diseases. Sets of standardized questionnaires were administered to 1,542 caretakers and heads of households with one or more child(ren) aged less than five years. The average household-size was 5.1 (range 1-15) persons. Most (90%) resided in a single room with monthly rents of US$ 4.50-7.00. Within the previous two weeks, 49% of children (n=1,378) aged less than five years (under-five children) and 18% of persons (n=1,139) aged ≥5 years experienced febrile, diarrhoeal or respiratory illnesses. The large majority (>75%) of illnesses were associated with healthcare-seeking.
While licensed clinics were the most-frequently visited settings, kiosks, unlicensed care providers, and traditional healers were also frequently visited. Expense was cited most often (50%) as the reason for not seeking healthcare. Of those who sought healthcare, 34-44% of the first and/or the only visits were made with non-licensed care providers, potentially delaying opportunities for early optimal intervention. The proportions of patients accessing healthcare facilities were higher with diarrhoeal disease and fever (but not for respiratory diseases in under-five children) than those reported from a contemporaneous study conducted in a rural area in Kenya. The findings support community-based rather than facility-based surveillance in this setting to achieve objectives for comprehensive assessment of the burden of disease.
November 28, 2011 – NAIROBI (Xinhua) — The urban poor in Kenya, especially those living in slum districts, spend two times more on health than other residents living in formal settlements.
Health experts say poor living conditions, lack of access to health facilities, coupled with little proportion of income make the urban poor spend more on health care.
“They averagely spend two times more on health than other residents living in formal settlement,” notes Dr Alex Ezeh, the Executive Director of the African Population and Health Research Centre (APHRC).
“If someone living in a middle-income estate uses 21 U. S. dollars a year on health, the urban poor ends up spending twice that amount in a year or even more,” he adds.
Kenya National Health Accounts report of 2009/2010 released recently shows families averagely use 34 dollars per person annually on healthcare.
Statistics from Kenya’s Ministry of Health indicate that close to 44 percent of people in the East African nation do not seek medical care because of high costs.
http://www.coastweek.com/kenxin_251111_04.htm
Journal of Urban Health: Bulletin of the New York Academy of Medicine, Vol. 88, Suppl. 2
Monitoring of Health and Demographic Outcomes in Poor Urban Settlements: Evidence from the Nairobi Urban Health and Demographic Surveillance System
Jacques Emina, et al.
The Nairobi Urban Health and Demographic Surveillance System
(NUHDSS) was set up in Korogocho and Viwandani slum settlements to provide a platform for investigating linkages between urban poverty, health, and demographic and other socioeconomic outcomes, and to facilitate the evaluation of interventions to improve the wellbeing of the urban poor. Data from the NUHDSS confirm the high level of population mobility in slum settlements, and also demonstrate that slum settlements are long-term homes for many people. Research and intervention programs should take account of the duality of slum residency. Consistent with the trends observed countrywide, the data show substantial improvements in measures of child mortality, while there has been limited decline in fertility in slum settlements. The NUHDSS experience has shown that it is feasible to set up and implement long-term health and demographic surveillance system in urban slum settlements and to generate vital data for guiding policy and actions aimed at improving the wellbeing of the urban poor.
Cost Recovery in Urban Water Services:Select Experiences in Indian Cities, 2011.
- Full-text (pdf)
Water and Sanitation Program
Water services in more than half of the 23 cities analyzed here are suffering substantial operational losses. None of these ULBS met their revenue potential, and most of them fail to cover their operational costs by up to 80 percent. It is true that low tariffs are a reason for this: tariffs are mostly based on estimates rather than quantified costs and margins. However, the study draws attention to the fact that a large part of cost recovery concerns operational factors such as low coverage of registered connections, high levels of leakage and NRW, poor metering practices, and inefficient billing and collection.
Glob Health Action. 2011; 4: 10.3402/gha.v4i0.5898.
Challenging urban health: towards an improved local government response to migration, informal settlements, and HIV in Johannesburg, South Africa
Joanna Vearey, African Centre for Migration & Society, University of the Witwatersrand, Johannesburg, South Africa
This article is a review of the PhD thesis undertaken by Joanna Vearey that explores local government responses to the urban health challenges of migration, informal settlements, and HIV in Johannesburg, South Africa. Urbanisation in South Africa is a result of natural urban growth and (to a lesser extent) in-migration from within the country and across borders. This has led to the development of informal settlements within and on the periphery of urban areas. The highest HIV prevalence nationally is found within urban informal settlements. South African local government has a ‘developmental mandate’ that calls for government to work with citizens to develop sustainable interventions to address their social, economic, and material needs.
Through a mixed-methods approach, four studies were undertaken within inner-city Johannesburg and a peripheral urban informal settlement. Two cross-sectional surveys – one at a household level and one with migrant antiretroviral clients – were supplemented with semi-structured interviews with multiple stakeholders involved with urban health and HIV in Johannesburg, and participatory photography and film projects undertaken with urban migrant communities.
The findings show that local government requires support in developing and implementing appropriate intersectoral responses to address urban health. Existing urban health frameworks do not deal adequately with the complex health and development challenges identified; it is essential that urban public health practitioners and other development professionals in South Africa engage with the complexities of the urban environment. A revised, participatory approach to urban health – ‘concept mapping’ – is suggested which requires a recommitment to intersectoral action, ‘healthy urban governance’ and public health advocacy.
Journal of Urban Health: Vol. 88, No. 5 2011.
Rights, Knowledge, and Governance for Improved Health Equity in Urban Settings
Françoise Barten, et al.
All three of the interacting aspects of daily urban life (physical environment, social conditions, and the added pressure of climate change) that affect health inequities are nested within the concept of urban governance, which has the task of understanding and managing the interactions among these different factors so that all three can be improved together and coherently. Governance is defined as: “the process of collective decision
making and processes by which decisions are implemented or not implemented”: it is concerned with the distribution, exercise, and consequences of power.
Although there appears to be general agreement that the quality of governance is important for development, much less agreement appears to exist on what the concept really implies and how it should be used. Our review of the literature confirmed significant variation in meaning as well as in the practice of urban governance arrangements.
The review found that the linkage between governance practices and health equity is under-researched and/or has been neglected. Reconnecting the fields of urban planning, social sciences, and public health
are essential “not only for improving local governance, but also for understanding and addressing global political change” for enhanced urban health equity. Social mobilization, empowering governance, and improved knowledge for sustainable and equitable development in urban settings is urgently needed. A set of strategic research questions are suggested.
Pathfinder Paper: Urban sanitation, 2011.
- Full-text (pdf)
Mulenga, M. Sanitation and Hygiene Applied Research for Equity (SHARE).
This paper discusses the common constraints to the provision of improved sanitation services to people living in low-income urban communities in Africa and makes suggestions on improved practice. The paper also highlights the current research gaps that SHARE could potentially examine over the next five years. Over the years, both African and Asian countries have faced enormous backlogs in the provision of sanitation services, especially in urban poor communities, resulting partly from the use of inappropriate service approaches. This is coupled with limited financial resources and rapid urbanisation and population growth.
This paper also shows that for the Millennium Development Goal target on sanitation to be achieved, there is need to develop effective links between communities and sanitation agencies and to use cheaper alternative sanitation technologies. Areas where sanitation improvements have been made there is normally a good relationship between the communities and the authorities. This paper is based on literature, work experience, interviews and SHARE country visits.
