New Report Assesses Programs To Improve Life in Latin America's Slums

May 26, 2011 · 0 comments

Regularization of Informal Settlements in Latin America looks at awarding titles, upgrading

CAMBRIDGE, Mass., May 10, 2011 /PRNewswire-USNewswire/ — Today one out of four urban residents in Latin America lives in a dwelling that does not have a legal title, or lacks urban services such as water and sanitation, or is constructed in a precarious location. Improving conditions in existing informal settlements and shantytowns in Latin American cities is a necessary and worthy goal, but the programs for “regularizing” these places have had mixed results so far, a new Lincoln Institute report says.

The two major approaches to regularization – legalizing parcels by awarding the occupants titles to the property as exemplified in Peru, and Brazil’s broader approach that combines titling with extensive upgrading of public services – both fall short of expectations. Titling by itself is relatively inexpensive but has not triggered neighborhood improvements, while upgrading is much more costly and can stimulate additional irregular development by those hoping to benefit from future upgrading.

The lack of revenue associated with regularization has inhibited the scaling up of such programs. Regularization programs can be more self-sustaining financially through property taxes and charges that capture some of the increases in land value caused by urban infrastructure and service improvements, according to Regularization of Informal Settlements in Latin America, the latest Policy Focus Report published by the Lincoln Institute of Land Policy.

“Customized, cost-effective, and sustainable approaches to upgrading have the potential to improve the lives of the many millions of people living in informal settlements,” said Gregory K. Ingram, president of the Lincoln Institute, “but regularization is a work in progress, and we need to learn more about what works.”

An estimated 127 million people in Latin American cities live in informal settlements, on public and private land, in many cases in neighborhoods that have existed for decades and physically resemble legal developments. Legal recognition is increasingly seen as the only realistic remedy for informal settlements, as evictions and massive relocations to new public housing are neither tolerated nor economically feasible in most countries.

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PBS – Pakistani Program Offers Affordable Health Insurance to Help Urban Poor

May 26, 2011 · 0 comments

May 23, 2011 – One program in Pakistan is attempting to combat urban poverty, the root of many Pakistanis’ problems, by providing affordable health insurance. Special correspondent Saima Mohsin reports from the nation’s largest city, Karachi.

An excerpt from the transcript: The private sector serves nearly 70 percent of Pakistan’s population. Yet, out of the estimated 40 million low-income families here, 99.3 percent of them don’t have health insurance.

The introduction of Naya Jeevan in Pakistan hopes to change that. This new program is simple and affordable for employers, sponsors and beneficiaries. The equivalent of just $2.50 a month provides access to private health care and, crucially, regular health checks for contagious or infectious diseases as a preventive measure for a country that is still battling polio, malaria and hepatitis.

And hundreds of local companies, restaurants and multinational corporations are signing up for the plan for their low-income employees.

Link to podcast, transcript and video: http://www.pbs.org/newshour/bb/world/jan-june11/pakistanhealth_05-23.html

WHO country profiles on urban health

May 25, 2011 · 0 comments

Country profiles were developed for the purpose of visualizing urban health issues, especially focused on urban health inequity.

These profiles cover key information on urban health with selected indicators of health outcomes, health system outputs, health risk factors, and health determinants. While not a comprehensive overview of health and its determinants these profiles provide a snapshot of some key issues in urban areas for which there is standardized available data across countries.

Link: http://www.who.or.jp/urbanheart/uhprofiles.html

How urban societies can adapt to resource shortage and climate change

May 23, 2011 · 0 comments

Phil. Trans. R. Soc. A 13 May 2011 vol. 369 no. 1942

How urban societies can adapt to resource shortage and climate change

Link to full-text

David Satterthwaite, International Institute for Environment and Development (IIED), 3 Endsleigh Street, London WC1H 0DD, UK

david@iied.org

With more than half the world’s population now living in urban areas and with much of the world still urbanizing, there are concerns that urbanization is a key driver of unsustainable resource demands. Urbanization also appears to contribute to ever-growing levels of greenhouse gas (GHG) emissions. Meanwhile, in much of Africa and Asia and many nations in Latin America and the Caribbean, urbanization has long outstripped local governments’ capacities or willingness to act as can be seen in the high proportion of the urban population living in poor quality, overcrowded, illegal housing lacking provision for water, sanitation, drainage, healthcare and schools.

But there is good evidence that urban areas can combine high living standards with relatively low GHG emissions and lower resource demands. This paper draws on some examples of this and considers what these imply for urban policies in a resource-constrained world. These suggest that cities can allow high living standards to be combined with levels of GHG emissions that are much lower than those that are common in affluent cities today. This can be achieved not with an over-extended optimism on what new technologies can bring but mostly by a wider application of what already has been shown to work.

India 'redefines' poverty for new survey

May 19, 2011 · 1 comment

May 19, 2011 – India’s cabinet has approved a proposal for a survey to identify people living below the poverty line, which also redefines what constitutes poverty.

It will classify the rural poor into “destitutes, manual scavengers and primitive tribal groups”.

Urban poor will be defined as those in vulnerable shelters, low-paid jobs and homes headed by women or children.

The survey, to be conducted alongside a caste census later this year, will help identify those who need state aid.

There are various estimates on the exact number of poor in India.

Officially, 37% of India’s 1.21bn people live below the poverty line. But one estimate suggests this figure could be as high as 77%.

The last poverty survey was conducted in 2002, but this is the first time that details about caste and religion will be included. The last caste census in India was in 1931.

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Nairobi – Affordable healthcare system for urban poor

May 19, 2011 · 0 comments

May 18, 2011 – Affordable healthcare systems boost safe motherhood for poor

When Zacharia Rombo and Samuel Agutu came together in 2008, the mission was simple — to develop a system that embraces technology to provide affordable healthcare.

This was informed by past experiences in their careers as chartered insurer and accountant respectively.

The result of this union was the birth of Changamka Micro Health Limited, a private company in the business of health insurance that targets the poor.

“It was after realising that not more than 10 per cent of Kenyans are insured under health schemes that we decided to go this way. The purpose was to get the uninsured poor who are the majority in the population, to a position to plan and afford medical care,” says Mr Rombo.

At the beginning, the initial focus was on general healthcare.

However, this has since changed to include safe maternal healthcare targeting 60 per cent of Kenyan women who deliver outside medical facilities.

Today, Changamka Micro Health is known for its popular smart card — the Changamka card — which allows members to save in advance for medical expenses to cover inpatient and outpatient services.

Unlike the common insurance schemes that restrict members to certain amounts of premiums for specified values of medical cover, the smart card allows for flexible contributions.

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Making a difference to health in slums: an HIV and African perspective

May 16, 2011 · 0 comments

The Lancet, Volume 377, Issue 9777, Pages 1571 – 1572, 7 May 2011

Making a difference to health in slums: an HIV and African perspective

Liz Thomas, Jo Vearey, Pinky Mahlangu

Priya Shetty’s World Report (Feb 19, p 627) makes a valuable contribution by highlighting the enormous challenges in health-care provision in slum contexts, the home of 33% of the developing world’s urban population.

An important yet missing factor in Shetty’s piece is that of HIV. Although the extensive concentration of 67% of the global HIV epidemic in sub-Saharan Africa is widely acknowledged, the spatial concentration of urban HIV in slum settings has received minimal attention. Research from South Africa and some other African countries shows that the HIV prevalence in slum populations is double (or more) that in the non-slum population of the same city.

This difference might be partly due to riskier behaviour of women living in slum settings.3 However, there is a complex interplay of upstream factors (before HIV infection) in slums, which include earlier sexual debut, lower condom use, and more partners than in non-slum areas in the same cities. A combination prevention approach, taking into account gender, education, overcrowding, food insecurity, and migration, is thus very important.

There is a real need for health-care and other service providers to “get the basics right”,4 including the provision of water, sanitation, and housing. Health services must also specifically address tuberculosis, HIV prevention, mother-to-child transmission of HIV, treatment of opportunistic infections, sustained access to antiretroviral therapy, and palliative care.
Accessibility, affordability, and acceptability are some of the challenges slum residents experience with the formal heath system. It is no longer possible to consider addressing health care for the urban poor in southern and eastern Africa without a strong focus on the HIV epidemic in slum settings.

Complete article with references

Dengue vector control strategies in an urban setting

May 13, 2011 · 0 comments

The Lancet, Volume 377, Issue 9778, Pages 1673 – 1680, 14 May 2011

Dengue vector control strategies in an urban setting: an economic modelling assessment

Dr Paula Mendes, et al.

Background - An estimated 2·5 billion people are at risk of dengue. Incidence of dengue is especially high in resource-constrained countries, where control relies mainly on insecticides targeted at larval or adult mosquitoes. We did epidemiological and economic assessments of different vector control strategies.

Methods - We developed a dynamic model of dengue transmission that assesses the evolution of insecticide resistance and immunity in the human population, thus allowing for long-term evolutionary and immunological effects of decreased dengue transmission. We measured the dengue health burden in terms of disability-adjusted life-years (DALYs) lost. We did a cost-effectiveness analysis of 43 insecticide-based vector control strategies, including strategies targeted at adult and larval stages, at varying efficacies (high-efficacy [90% mortality], medium-efficacy [60% mortality], and low-efficacy [30% mortality]) and yearly application frequencies (one to six applications). To assess the effect of parameter uncertainty on the results, we did a probabilistic sensitivity analysis and a threshold analysis.

Findings - All interventions caused the emergence of insecticide resistance, which, with the loss of herd immunity, will increase the magnitude of future dengue epidemics. In our model, one or more applications of high-efficacy larval control reduced dengue burden for up to 2 years, whereas three or more applications of adult vector control reduced dengue burden for up to 4 years. The incremental cost-effectiveness ratios of the strategies for two high-efficacy adult vector control applications per year was US$615 per DALY saved and for six high-efficacy adult vector control applications per year was $1267 per DALY saved. Sensitivity analysis showed that if the cost of adult control was more than 8·2 times the cost of larval control then all strategies based on adult control became dominated.

Interpretation - Six high-efficacy adult vector control applications per year has a cost-effectiveness ratio that will probably meet WHO’s standard for a cost-effective or very cost-effective intervention. Year-round larval control can be counterproductive, exacerbating epidemics in later years because of evolution of insecticide resistance and loss of herd immunity. We suggest the reassessment of vector control policies that are based on larval control only.

Primedic: Affordable Health Care For The Urban Poor

May 5, 2011 · 0 comments

Excerpt – Primedic, a primary care medical service provider dedicated to offering low-cost medical consultations to the urban base of the socio-economic pyramid population backed by impact investing venture capital fund IGNIA.  Primedic’s model is simple enough, yet innovative.  Pay an individual monthly membership fee of about $10 and receive access to unlimited medical consultations with medical specialists in internal medicine, pediatrics and gynecology.  As opposed to general practitioners who usually would have to refer a patient to someone with further training for more complex cases, patients at Primedic immediately get access to doctors with a specialty degree.  Given the “membership” nature of their product, Primedic seeks to change customer behaviors and incentivize preventive medical care through a low-cost high-quality program.

In the case of Conchita, she purchased her membership and immediately asked to be seen by a doctor.  She was seen that same day by a gynecologist who immediately diagnosed something alarming: an ectopic pregnancy, a complication of pregnancy in which the pregnancy implants outside the uterine cavity. Beyond making the pregnancy impossible, Conchita’s life was in severe danger due to internal bleeding.  The doctor’s diagnosis gave her less than 24 hours to live if she remained untreated.  Given the urgency of the situation, Primedic made the necessary arrangements to put Conchita on an operating table at a local private hospital less than four hours after the initial diagnosis.

Link to complete article, Forbes, April 25, 2011

Alternative to Conventional Public Water Service: “User Group Networks” in Mumbai

May 5, 2011 · 0 comments

AN ALTERNATIVE TO CONVENTIONAL PUBLIC WATER SERVICE : “USER GROUP NETWORKS” IN A MUMBAI SLUM, 2011.

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Rémi de BERCEGOL, Adeline DESFEUX. Centre for Human Sciences.

Providing universal access to drinking water remains a formidable challenge in the cities of developing countries and all potential technical and institutional solutions need to be taken into account. By looking at the specific example of “user group networks” set up in a poor neighbourhood in the North-East of Mumbai, this article aims to highlight the ability of local communities to design and run functional systems that compensate for shortcomings in the public service.

We will analyse the effective role that users play in regulating these groups at local level as well as the political-territorial implications of this type of management. After providing a clear overview of the systems that have emerged and their modus operandi, we will describe and assess them from a critical technical/economic perspective in order to suggest possible improvements. More generally, our research is part of a broader attempt to study the different ways of providing access to urban water and the legitimacy of local communities in taking the process in hand. We wish to contribute to the debate that focuses on providing a differentiated service to the inhabitants of the same city.

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