The latest issue of the Urban Health Bulletin is now posted on the Environmental Health at USAID website at: http://www.ehproject.org/PDF/ehkm/urban_health-octnov09.pdf (pdf, 106KB)

This issue contains citations and abstracts of 20 recently published studies from: Benin, Brazil, India, Indonesia, Kenya,  Morocco,  Mozambique, Pakistan and Zambia. 

Please contact USAID’s Urban Health Advisor, Anthony Kolb, akolb@usaid.gov , if you have any comments or would like to have your projects or reports featured in the Urban Health Bulletin.

Reforms in health care systems can act as a powerful mechanism of social exclusion of the urban poor from decent health care services. This concludes WOTRO researcher Tausi Mbaga Kida. In her study she shows that the dual system of private and public health care delivery in Tanzania excluded urban poor from the better quality private care. But even more striking, also public care became less accessible for the poor due to the current subsidy structure.

In her study Tausi Kida analyses the systemic behaviour of the dynamics of the health care systems with its interaction with poverty. The deregulation and liberalisation of the health sector adopted in Tanzania from early 1990’s has brought about a dramatic shift in the system of health care delivery, from near exclusive ‘free’ public provisioning towards its extensive commercialisation that also include the liberalisation of private health care provision.

An influential view in the literature and in policy practice postulates that the commercialization of health care services will move the better off towards the private facilities in the public-private mix, thereby freeing the subsidized public health facilities for the use of the poor. However, contrary to policy intentions, this study finds out that the urban poor frequently find themselves excluded not only from (decent) private health care, but also from access to public health care, given the current subsidy structure.

Furthermore, this study reveals existence of segmentation in provision and access of health care services in the urban health care market. The segmentation mechanism is mainly the result of the systemic process of interaction of the demand and the supply sides of the health care market with widespread poverty. The study reveals that segmentation of health care delivery into a two-tier system is questionable to secure better access to health care especially for the urban poor. This is mainly because greater plurality of service provisioning in urban areas have weakened the pattern of public health care provision in general and of urban primary health care units in particular.

In this regard, this study proposes that the health reforms in practice have turned out to be quite powerful mechanisms of social exclusion of the urban poor from access to decent health care services i.e instead of being inclusionary as intended by policy. This study has therefore adopted “policy as process” approach, that has enabled a careful empirical investigation of both intended and unintended outcomes of prescribed policies – i.e. health reforms in the context of wide spread poverty.

Source – http://www.nwo.nl/nwohome.nsf/pages/NWOP_7Y4H6N

Getting land for housing; what strategies work for low-income groups?

Full-text – http://www.iied.org/pubs/pdfs/10580IIED.pdf (pdf, 107KB)

Oct 2009 – IIED

The struggle by low-income groups in urban areas to get housing and basic services is often a struggle either to get land on which to build or to get tenure of land they already occupy. Their drive to get land, their energy and their capacity are never factored into official housing policies. In many nations, the last 10 years have shown how the scale and scope of what they can do is much increased when they are organized through federations of savings groups and these federations are offering government partnerships in addressing their needs for housing and services.

Where national and local governments respond positively, much can be achieved as shown by government–federation partnerships in Thailand, the Philippines, Zimbabwe, Sri Lanka and Cambodia. Even local governments with limited funding and capacity can increase the supply and reduce the cost of land for housing through allocating publicly owned land, through making available land for housing by extending infrastructure and services to new areas, and through pro-poor changes to building and land use regulations and the ways these are applied.

Organized urban poor groups have also shown how they can often negotiate an affordable price with the owner of the land they occupy, if supported to do so (as in Thailand and the Philippines). Urban poor groups also find ways to narrow the gap between the cost of the land they need and what they can afford – smaller plot sizes (although this has to be negotiated with the authorities) and incremental building, and the use of credit (so costs are spread over time). This may be helped by careful use of subsidies. What delivers for the urban poor is not the provision of legal title but governments and international agencies that listen to, work with and support them, including providing finance that they can draw on as and when needed.

Bulletin of the World Health Organization; forthcoming article, Article DOI: 10.2471/BLT.09.068486

Fatal injuries among urban children in South Africa: risk distribution and potential for reduction

Full-text: http://www.who.int/bulletin/volumes/87/09-068486.pdf

Stephanie Burrows, Ashley van Niekerk & Lucie Laflammec

Objective To determine the leading causes of fatal injury for urban South African children aged 0–14 years, the distribution of those causes and the current potential for safety improvements.

Methods – We obtained injury surveillance data from the National Injury Mortality Surveillance System 2001-2003 for six major South African cities varying in size, development and sociodemographic composition. We calculated age-adjusted rates, by sex, population group and city, for death from the five leading causes of
fatal injury as well as population attributable risks (PARs).

Findings – The leading causes of fatal injury in childhood included road traffic injuries – among vehicle passengers and especially among pedestrians – drowning, burns and, in some cities, firearm injuries. Large differences in PARs were observed, particularly for population groups and cities. Disparities between
cities and between population groups were largest for deaths from pedestrian injuries, while differences between boys and girls were greatest for drowning deaths.

Conclusion – In the face of the high variability observed between cities and population groups in the rates of the most common types of fatal injuries, a safety agenda should combine safety-for-all countermeasures – i.e. lowering injury rates for all – and targeted countermeasures that help reduce the burden for those at greatest risk.

Urban biodiversity and Dhaka dwellers

Cities are growing rapidly, in 50 years more than 80% of the world’s population will live in an urban environment. Urban green areas e.g. parks and gardens, woodlands and forests with socio-cultural values are important for urban life. Moving in search of a better life, people across the globe have abandoned traditional socio-economic systems, broken ecological bonds with nature, and flocked to urban centers. While this process started in the “northern” or “developed” world, less developed countries have quickly caught up.

Sustainable urban development requires providing a healthy and sustainable living environment with basic services for all. A healthy and multifunctional urban green structure is one of the basic services to provide. Urban and peri-urban forestry (UPF), focusing on the tree-dominated part of urban and periurban green space, is a strategic, integrative, interdisciplinary, and participatory approach. Its goal is to sustainably develop the multiple benefits of forests and trees in urban environments.

Ongoing urbanization has brought about a wide range of challenges across the globe, and not only in terms of population growth. In the United States, for example, metropolitan areas tripled in size between 1950 and 1990. More land is needed for urban areas to provide inputs and outputs of resources and energy, with a detrimental effect on forests and other green areas. During the early 1990s, more than a quarter of green spaces in Asia were expected to be lost within two decades due to continued urbanization and suburbanization.

Continuing urbanization in the developing world has led to major problems in terms of hunger, poverty, inadequate shelter, social segregation, unemployment, pollution of water, soil, and atmosphere; and so onward.

Experiences and research during recent years have shown that urban green structures are more than just “icing on the cake.”

The thought of urban forestry is new in Dhaka. As a developing country, city authorities are busy most of the time to give service facilities to the people rather than think about green resources. Most of the time different green institutions in the city and government deal with big urban greening programme by tree plantation activities. There are no exact areas wise statistics for the percentage of trees in the city and also no area wise planning for tree plantation. In 2002 Dhaka City Corporation (DCC) were able to plant only 29 thousand trees out of the targeted 45 thousand because of lack of empty space. In 2003, DCC has planned to plant six thousand trees to replace those that have been uprooted, and a further ten thousand in whatever empty space is available in Uttara and Mirpur area of Dhaka. But adequate open spaces are needed for the sustainable development of a city.

Let’s discuss why we really need urban biodiversity in term of social, economic and environmental context.

Nursery activity is an important entrepreneurial outlet for the poor people. 78% of nursery owners indicated that the management of their nursery is their only employment. The average daily sales of the nurseries surveyed exceeded USD 130, the biggest and most successful one third of nurseries, however, have average daily sales in excess of USD 190.

Considering among data it can be assume that most of the beneficiary of this industry are low income groups of the urban area.

In Dhaka studies shown that suspended particulate matter (SPM) and ambient sulphur dioxide levels of air pollution are about 4 times and 5 times higher than the levels prescribed in Bangladesh Air Quality Standard. An ADB report shown that 3,850 premature deaths could be avoided had there been a reduction of SPM concentrations in Dhaka to the level of Bangladesh Air Quality Standard.

Economic cost, because of such deaths and illnesses in Bangladesh, may reach US $800 Million a year. One of the most effective ways to control air pollution is creating more woodland around the city and increasing the number of trees in the parks and street in Dhaka. The SPM can be captured by the leaves of evergreen tree species .Several research in US revealed that trees can remove pollution by intercepting airborne particles. In 1994, trees in New York City removed an estimated 1,821 metric tons of air pollution at an estimated value to society of $ 9.5 million. Another study found that woodland in Nottingham was estimated to reduce concentrations of sulphur dioxide and nitrogen oxides in the air by 4-5%.It is also well known that all vegetation absorb carbon dioxide and release oxygen, do purifying the air.

It found that in Dhaka 33% inhabitants experience hearing problems from noise pollution. But increasing trees and other vegetation can play an important role in attenuating noise through and absorbing sound energy. In US one research estimate suggested that 7db noise reduction was achieved for every 33m of forest while other reported field tests show apparent loudness reduced by 50% by wide belts of trees and soft ground.

According to Dhaka city structure plan 1995-2015 policy 10 &11 demands the augmenting of city open space and securing the future open space although there have no specific policy which can support sustainable livelihood.

Well-planned and well managed green areas are essential for environmental and high quality of life for Dhaka city dwellers. So it is very much for RAJUK and Dhaka City Corporation to rethink about these issues and necessary actions need to be taken.

Source – The New Nation

Addis Ababa, November 17 (WIC) – Health Minister Dr. Tewodros Adhanom, said urban health extension program is underway across the country so as to improve health service of urban dwellers.

Dr. Tewodros told WIC recently that the program is being implemented in urban areas of all states as well as Addis Ababa and Diredawa administration.

The Minister said 5,400 urban health extension workers have been trained for the successful implementation of the program.

Some 1,200 urban health extension workers are required in Addis Ababa alone, Dr. Tewodros said, adding the workers would provide door- to -door health service to the residents.

Some 30,190 health extension workers have already been deployed across the country excluding the 5,400 workers due to be assigned in urban areas, it was learnt.

Source – Walta Info

A health check on capital-ists, 20 Nov 2009

THIRUVANANTHAPURAM: It’s not easy to handle the mantle of being the capital city. From its air, water and roads, everything counts.

A survey to check on the health status of the capital city’s population is being done by two major research centres of the Kerala University. The survey is titled ‘Urban Health: searching for patterns, differentials and correlations of Thiruvananthapuram corporation using GIS technology’.

It’s the Population Study Centre and the Centre for Geoinformation Science and Technology who are conducting the ambitious survey. Not only is the survey an effort to model the patterns of urban health, it also aims to find out the relation of personal health with natural parameters like availability of water, cleanliness and pollution.

It does not end there. The habits of citizens in the area of health, like their treatment-seeking pattern, access to treatment points and even the quality of drinking water would be surveyed.

As part of the survey, the surveyors will measure the sugar level as well as BP. This will be done free of cost. The details of these analyses will be handed over to the citizens.

“The survey would also examine various factors like mosquito breeding centres in the vicinity and the quality of the water in the local well,’’ said S. Santhosh, additional director in charge of the Population Study Centre.

“The PH value of the water in the wells will be studied. Apart from that, the water in the well will be sent to the lab for testing. These results will also be made available to the persons concerned,’’ he said.

The survey would also try to identify the reproductive and healthcare problems of the female population in the city. A health screening report of the households will be prepared on the basis of the survey, he said.

The pilot survey has been kicked off in selected wards in the coastal, rural, semi-urban and urban areas of the Corporation. In the next stage, the survey would be extended to all wards of the Corporation.

The Population Research Centre had earlier conducted a landmark survey, the ‘National Family Health Survey’, in 1992-93.

At present, seven surveys conducted by the centre are in progress and the major one is the ‘Baseline Survey on Reproductive and Child Health’ in Kozhikode and Palakkad districts.

Source – Express Buzz

MONROVIA, 19 November 2009 (IRIN) – Water and sanitation services in the Liberian capital, Monrovia, are getting worse as a growing urban population tries to squeeze more out of already skeletal services. On 19 November, World Toilet Day, NGOs are calling on the government to up its allocation, and on international donors to reprioritize funding to stamp out cholera and cut child mortality.

Just one-third of Monrovia’s 1.5 million residents have access to clean toilets, and 20 to 30 cholera cases are reported weekly; in 2008 there were 888 suspected cases, 98 percent of them in Monrovia’s overcrowded shantytowns such as West Point, Buzzi Quarter, Clara Town, and Sawmill.

Poor or non-existent clean water and sanitation facilities are linked to high malaria and diarrhoea rates, Liberia’s two leading child killers

In the Clara Town slum, 75,000 people share 11 public toilets and 22 public taps; West Point’s 70,000 residents must make do with just four public toilets, said Bessman Toe, head of the Montserrado County slum-dweller association, which represents over 40 slum communities in and around the capital.

Some households build their own toilets, but these tend to collapse during the seven-month rainy season, Oxfam emergency health engineer Jennifer Lamb told IRIN, so people defecate in the narrow alley-ways between their houses, on the beach, or into plastic bags, which they dump on nearby piles of rubbish or into the sea.

Read More – http://www.irinnews.org/Report.aspx?ReportId=87110

Newborn care practices among slum dwellers in Dhaka, Bangladesh: a quantitative and qualitative exploratory study.

Author: Allisyn Moran, Nuzhat Choudhury, et al.  Credits/Source: BMC Pregnancy and Childbirth 2009, 9:54

Urbanization is occurring at a rapid pace, especially in low-income countries. Dhaka, Bangladesh, is estimated to grow to 50 million by 2015, with 21 million living in urban slums.

Although health services are available, neonatal mortality is higher in slum areas than in urban non-slum areas. The Manoshi program works to improve maternal, newborn, and child health in urban slums in Bangladesh.

This paper describes newborn care practices in urban slums in Dhaka and provides program recommendations.

Method – A quantitative baseline survey was conducted in six urban slum areas to measure newborn care practices among recently delivered women (n=1,256). Thirty-six in-depth semi-structured interviews were conducted to explore newborn care practices among currently pregnant women (n=18) and women who had at least one delivery (n=18).

Results: In the baseline survey, the majority of women gave birth at home (84%).

Most women reported having knowledge about drying the baby (64%), wrapping the baby after birth (59%), and cord care (46%). In the in-depth interviews, almost all women reported using sterilized instruments to cut the cord.

Babies are typically bathed soon after birth to purify them from the birth process. There was extensive care given to the umbilical cord including massage and/or applying substances, as well as a variety of practices to keep the baby warm.

Exclusive breastfeeding was rare; most women reported first giving their babies sweet water, honey and/or other foods.

Conclusions: These reported newborn care practices are similar to those in rural areas of Bangladesh and to urban and rural areas in the South Asia region. There are several program implications:

  • Educational messages to promote providing newborn care immediately after birth, using sterile thread, delaying bathing, and ensuring dry cord care and exclusive breastfeeding are needed.
  • Programs in urban slum areas should also consider interventions to improve social support for women, especially first time mothers.

These interventions may improve newborn survival and help achieve MDG4.

November 16, 2009 Addis Ababa (U.S. Embassy): The United States Agency for International Development’s (USAID) Urban Gardens Program today launched a two-day conference called “Beyond Urban Gardens: Meeting the Growing Needs of Ethiopia’s Urban Population.” The conference highlights the challenges and the opportunities for urban gardening in combating HIV/AIDS and addressing food security, livelihoods, and health issues of urban populations in Ethiopia.

The USAID Urban Gardens Program for HIV-Affected Women and Children, funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), began in Ethiopia five years ago. Since October 2008, the program has helped more than 15,000 women and children and 5,000 households to generate income, adhere to AIDS treatment protocols, improve their nutrition and health, and boost their attendance at school.

The program operates in six cities — Adama, Addis Ababa, Awassa, Bahir Dar, Dessie, and Gondor. In these urban areas, the USAID Urban Gardens Program creates school and community gardens using water saving methods such as trickle and drip technologies. Where possible, the program also has promoted the cultivation of fruit trees and the raising of poultry. While supporting the development of urban gardens in Ethiopia, the USAID Urban Gardens Program also assists program participants through referrals to health services offered by government and community-based organizations.

In opening the conference, USAID/Ethiopia Mission Director Thomas H. Staal said, “Interventions like urban gardens give people hope. They give women and children the opportunity to improve their health and raise income for their families’ needs.”

More and more, people worldwide are planting urban gardens as populations in cities continue to grow and health and livelihood needs increase. First Lady of the United States Michelle Obama raised the profile of urban gardening recently when she invited a group of children to the White House in March to help her plant a vegetable garden on the White House grounds, the first such garden at the White House in 60 years. The Ethiopian Urban Agriculture Office used the conference to release its draft urban agriculture strategy.

As part of the “Beyond Urban Gardens” conference, Ethiopian youth involved in USAID Urban Gardens Program will share their experiences and best practices via digital video conference with teenagers from a high school in Detroit, Michigan, who also engage in urban agriculture.

Source – Ethoblog