Urban Health Updates — from the WASHplus Project

Maternal and neonatal health expenditure in mumbai slums (India)

April 6, 2011 · 0 comments

BMC Public Health. 2011 Mar 8;11:150.

Maternal and neonatal health expenditure in mumbai slums (India): A cross sectional study.

Skordis-Worrall J, et al. UCL Centre for International Health and Development, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK. j.skordis-worrall@ucl.ac.uk.

BACKGROUND: The cost of maternity care can be a barrier to access that may increase maternal and neonatal mortality risk. We analyzed spending on maternity care in urban slum communities in Mumbai to better understand the equity of spending and the impact of spending on household poverty.

METHODS: We used expenditure data for maternal and neonatal care, collected during post-partum interviews. Interviews were conducted in 2005-2006, with a sample of 1200 slum residents in Mumbai (India). We analysed expenditure by socio-economic status (SES), calculating a Kakwani Index for a range of spending categories. We also calculated catastrophic health spending both with and without adjustment for coping strategies. This identified the level of catastrophic payments incurred by a household and the prevalence of catastrophic payments in this population. The analysis also gave an understanding of the protection from medical poverty afforded by coping strategies (for example saving and borrowing).

RESULTS: A high proportion of respondents spent catastrophically on care. Lower SES was associated with a higher proportion of informal payments. Indirect health expenditure was found to be (weakly) regressive as the poorest were more likely to use wage income to meet health expenses, while the less poor were more likely to use savings. Overall, the incidence of catastrophic maternity expenditure was 41%, or 15% when controlling for coping strategies. We found no significant difference in the incidence of catastrophic spending across wealth quintiles, nor could we conclude that total expenditure is regressive.

CONCLUSIONS: High expenditure as a proportion of household resources should alert policymakers to the burden of maternal spending in this context. Differences in informal payments, significantly regressive indirect spending and the use of savings versus wages to finance spending, all highlight the heavier burden borne by the most poor. If a policy objective is to increase institutional deliveries without forcing households deeper into poverty, these inequities will need to be addressed. Reducing out-of-pocket payments and better regulating informal payments should have direct benefits for the most poor. Alternatively, targeted schemes aimed at assisting the most poor in coping with maternal spending (including indirect spending) could reduce the household impact of high costs.

Pedro Malan – Creating healthy people and cities

April 5, 2011 · 0 comments

April 5, 2011

The forces that drove the growth of European and North American cities in the 19th and 20th centuries are now driving urbanization in Brazil, China, India, Mexico, Russia and other emerging market countries. Because the growth of these cities has been accelerated and magnified by productive technologies, rapid internal migration, and high net reproduction rates, many have reached unprecedented sizes at breathless speed. Indeed, all but three of the world’s 20 largest cities are in emerging markets.

Many forecasts suggest that by 2030, the four largest emerging market economies will have overtaken the Group of Seven in combined size, and that by 2050, today’s emerging market economies will represent more than half the global economy and an even larger share of the world’s population. These forecasts all assume that economic growth will be generated in cities.

But will emerging market cities be healthy enough to drive rapid economic growth? The issues that preoccupy health policymakers and practitioners in Lima, Cairo, Kolkata and Jakarta reflect contrasting climates, geographies, histories and cultures. Each city is ultimately a special case. But they share some generic features.

One is that the urban disease burden is shifting from infectious to chronic diseases — the so-called “diseases of affluence.” But the urban poor, faced with bad housing, limited infrastructure and meager services, are vulnerable to epidemics, malnutrition-based childhood diseases, HIV/AIDS, malaria, tuberculosis and mental disorders. They are also likely to be hardest hit by natural disasters, such as the floods and mudslides that devastated parts of Rio de Janeiro in January.

A second generic feature of emerging market cities is that dense concentrations of poverty help create fragile environments that spawn civil disorders, resulting in death and injuries. But a recent symposium at Oxford University concluded that emerging market cities could improve and maintain urban health by capturing the inherent advantages of concentration, coordinating health policies and programs, adopting successful innovations, reforming health education and training, and developing improved planning processes.

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Nepal – City slum dwellers' health condition appalling

April 1, 2011 · 0 comments

KATHMANDU, March 6: Even after more than two years of the announcement of free birth services and an encouragement allowance to promote delivery at government hospitals, a survey has revealed that many women living in slum areas of Kathmandu are either unaware of it or reluctant to benefit from the free service.

Of the total births in Kathmandu slums, 40 percent took place without medical assistance, according to the survey conducted in 2009\2010 by Kathmandu Metropolitan City (KMC). Such deliveries can lead to complications in the health of both the mother and the newborn.

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Monetary burden of health impacts of air pollution in Mumbai, India

March 31, 2011 · 0 comments

Public Health. 2011 Mar;125(3):157-64.

Monetary burden of health impacts of air pollution in Mumbai, India: Implications for public health policy.

Patankar AM, Trivedi PL. K.J. Somaiya Institute of Management Studies and Research, Vidyavihar (East), Mumbai 400077, India.

OBJECTIVES: Mumbai, a mega city with a population of more than 12 million, is experiencing acute air pollution due to commercial activity, a boom in construction and vehicular traffic. This study was undertaken to investigate the link between air pollution and health impacts for Mumbai, and estimate the monetary burden of these impacts.

STUDY DESIGN: Cross-sectional data were subjected to logistic regression to analyse the link between air pollution and health impacts, and the cost of illness approach was used to measure the monetary burden of these impacts.

METHODS: Data collected by the Environmental Pollution Research Centre at King Edward Memorial Hospital in Mumbai were analysed using logistic regression toinvestigate the link between air pollution and morbidity impacts. The monetary burden of morbidity was estimated through the cost of illness approach. For this purpose, information on treatment costs and foregone earnings due to illness was obtained through the household survey and interviews with medical practitioners.

RESULTS: Particulate matter (PM(10)) and nitrogen dioxide (NO(2)) emerged as the critical pollutants for a range of health impacts, including symptoms such as cough, breathlessness, wheezing and cold, and illnesses such as allergic rhinitis and chronic obstructive pulmonary disease (COPD). This study developed the concentration-response coefficients for these health impacts. The total monetary burden of these impacts, including personal burden, government expenditure and societal cost, is estimated at 4522.96 million Indian Rupees (INR) or US$ 113.08 million for a 50-μg/m(3) increase in PM(10), and INR 8723.59 million or US$ 218.10 million for a similar increase in NO(2).

CONCLUSIONS: The estimated monetary burden of health impacts associated with air pollution in Mumbai mainly comprises out-of-pocket expenses of city residents. These expenses form a sizable proportion of the annual income of individuals, particularly those belonging to poor households. These findings have implications for public health policy, particularly accessibility and affordability of health care for poor households in Mumbai. The study provides a rationale for strengthening the public health services in the city to make them more accessible to poor households, especially those living in the slums of Mumbai.

Kibera, Kenya – Community Turns Garbage Into Energy Source

March 31, 2011 · 0 comments

Kibera, Kenya – Community Turns Garbage Into Energy Source

A community-based organisation in the Kenyan slum area of Kibera set out to clean up garbage and deal with waste water; Ushiriki Wa Safi ended up creating a community cooker that turns waste into an energy source.

Open sewers and piles of garbage are an all too familiar scene in many of Kenya’s poorest urban areas. Local authorities are invisible in most of these slums, and poor public hygiene and the absence of sanitation leaves residents to their own devices to maintain a level of cleanliness and keep diseases like diarrhoea at bay.

But some have seen this as an opportunity to bring about change to communities. Ushirika Wa Safi – (loosely translated, the name means “an association to maintain cleanliness” in Swahili) – a community-based organisation in Kibera, was formed to deal with the garbage problem in Laini Saba, one of the thirteen villages that form Kibera slums, often described as Africa’s largest.

The CBO has come up with a remarkable solution in the form of a community cooker that turns garbage into energy. It is a recycling project that is transforming the lives of local residents.

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Determinants of latrine usage in urban poverty pockets in Bhopal

March 31, 2011 · 0 comments

Trop Med Int Health. 2011 Mar 17

Patterns and determinants of communal latrine usage in urban poverty pockets in Bhopal, India.

Biran A, Jenkins MW, Dabrase P, Bhagwat I.

Objectives: To explore and explain patterns of use of communal latrine facilities in urban poverty pockets.

Methods: Six poverty pockets with communal latrine facilities representing two management models (Sulabh and municipal) were selected. Sampling was random and stratified by poverty pocket population size. A seventh, community-managed facility was also included. Data were collected by exit interviews with facility users and by interviews with residents from a randomly selected representative sample of poverty pocket households, on social, economic and demographic characteristics of households, latrine ownership, defecation practices, costs of using the facility and distance from the house to the facility. A tally of facility users was kept for 1 day at each facility. Data were analysed using logistic regression modelling to identify determinants of communal latrine usage.

Results: Communal latrines differed in their facilities, conditions, management and operating characteristics, and rates of usage. Reported usage rates among non-latrine-owning households ranged from 15% to 100%. There was significant variation in wealth, occupation and household structure across the poverty pockets as well as in household latrine ownership. Households in pockets with municipal communal latrine facilities appeared poorer. Households in pockets with Sulabh-managed communal facilities were significantly more likely to own a household latrine. Determinants of communal facility usage among households without a latrine were access and convenience (distance and opening hours), facility age, cleanliness/upkeep and cost. The ratio of male to female users was 2:1 across all facilities for both adults and children.

Conclusions: Provision of communal facilities reduces but does not end the problem of open defecation in poverty pockets. Women appear to be relatively poorly served by communal facilities and, cost is a barrier to use by poorer households. Results suggest improving facility convenience and access and modifying fee structures could lead to increased rates of usage. Attention to possible barriers to usage at household level associated particularly with having school-age children and with pre-school childcare needs may also be warranted.

Stanford University – Child Health Implications of Reorganizing the Urban Water Sector

March 31, 2011 · 0 comments

The Child Health Implications of Reorganizing the Urban Water Sector, January 2011.

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Katrina Kosec, Stanford University.

Each year, diarrheal diseases claim the lives of nearly 2 million people{ninety per-cent of them children under the age of five. The problem is especially critical in Africa, which has ten percent of the world’s population but accounts for forty per-cent of child deaths. Can private sector participation (PSP) in the urban pipedwater industry improve child health? Allowing the private sector to provide basic infrastructure such as piped water is politically controversial, with some arguing that the private sector is more ecient and will lead to improvements in accessand quality, and others arguing that privatization will cause access and quality tosuer.

This paper uses a novel panel dataset on the sub-national regions of 25 African countries over 1985-2006 to shed light on this question. This is the period during which nearly all African countries that today have PSP in water introduced those arrangements. analysis suggests that the introduction of PSPdecreases diarrhea among under-ve children by about four percentage points, or23%. An instrumental variables analysis that uses variation in the share of theworld water market controlled by former colonizing countries suggests that the effects may be twice as large. The difference between the OLS and the IV results can be explained by the fact that privatization is more likely when the water sector is already distressed and causing health problems.

Importantly, the diarrheal disease reduction benefits of PSP appear to be greatest among the least-educated households, and smallest among the most-educated households. PSP in water also appears to be associated with signicantly higher rates of reliance on piped wateras the primary water source, suggesting that increased access may be driving child health improvements.

An Ecosystems Approach to Water Resources Management for African Cities

March 28, 2011 · 0 comments

Green Hills, Blue Cities: An Ecosystems Approach to Water Resources Management for African Cities. A Rapid Response Assessment, 2011.

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Mafuta, C., Formo, R. K., and Nellemann, C. (eds). 2011.

United Nations Environment Programme, GRID-Arendal.

CONTENTS

SUMMARY

RECOMMENDATIONS

URBANISATION – WATER – ECOSYSTEMS NEXUS

URBANIZATION, WATER AND ECOSYSTEMS:THE CASE OF NAIROBI

WATER SUPPLY AND SANITATION IN GRAHAMSTOWN:A HISTORICAL PERSPECTIVE

WATER AND SANITATION IN PORT HARCOURT

URBAN WATER RESOURCES MANAGEMENT CHALLENGES: THE CASE OF YAOUNDÈ

PRO-POOR SOLUTIONS TO URBAN WATER SUPPLYAND SANITATION: THE CASE OF KAMPALA

PRO-POOR SANITATION SOLUTIONS THE CASE OF DAKAR

URBANISATION AND WATER POLLUTION IN ADDIS ABABA

WATER RESOURCES MANAGEMENT – OPTIONSFOR SUSTAINABLE CITIES

RECOMMENDATIONS

Growing cities heighten clean water, sanitation concerns

March 22, 2011 · 0 comments

March 22, 2011 – Securing a safe water supply in urban areas is an increasing problem in 2011. The UN recognizes access to clean drinking water as a human right, but it remains out of reach for millions of people around the world.

Some 400 million people in Africa live in urban areas, according to United Nations statistics – but as of 2008, 55 million of them lacked access to clean drinking water.

A study by two UN agencies, released Monday to coincide with World Water Day on March 22, highlighted a troubling trend: As Africa’s cities grow more populous, an increasing number of residents there must do without clean water and sanitation facilities.

All over the globe, more people are moving to urban areas. The International Union for Conservation of Nature, IUCN, says 50 percent of the world’s population lives in cities – and that number is estimated to grow over the next 20 years to some 5 billion people.

“The problem is that with everybody moving to these concentrated areas, it puts a big strain on water resources,” James Dalton, water management advisor for the IUCN Water Programme told Deutsche Welle.

Rapid urbanization is taking place the world over, as people move to the city and away from rural areas to find work. Often, urban spaces lack adequate water infrastructure to support a growing population, and expanding the grid isn’t an easy proposition.

“That’s costly to countries that have a number of competing priorities for funding,” Dalton said. Recovering those costs often means tariffs for users – many of whom are used to getting water for free.

Health hazard

Ensuring that water is safe to drink and that sewage stays out of the water supply may entail extra expenses, but the consequences of consuming untreated water are even more costly.

Pablo Solon, Bolivia’s ambassador to the United Nations, said diseases caused by lack of access to drinking water and sanitation “cause more deaths than any war.”

“The lack of access to clean water kills more children than does AIDS, malaria and measles combined,” he said.

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