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

May 16, 2011 Leave a comment

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

Categories: Africa Tags: ,

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

March 31, 2011 Leave a comment

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 fi ve. 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 tosu er.

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 di fference 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 bene fits 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 signi cantly 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 Leave a comment

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

World Bank research – experience with water standposts and the informal water sector

March 18, 2011 Leave a comment

Provision of water to the poor in Africa : experience with water standposts and the informal water sector, 2010.

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Keener, Sarah; Luengo, Manuel; Banerjee, Sudeshna. World Bank.

Standpipes that dispense water from utilities are the most common alternatives to piped water connections for poor customers in the cities of Sub-Saharan Africa. Fifty-five percent of the unconnected urban population relies on standpipes as their first water source. Other informal water providers include household resellers and a variety of water tankers and vendors, which are the first water source of 1 percent and 3 percent of the urban population, respectively.

In the cities studied, the percentage of unconnected households ranges from 12 percent to 86 percent of the population. The percentage of unconnected people covered by standpipes is substantially higher for countries with higher rates of household connection, while the percentage of unconnected people covered by water tankers or water vendors is higher for countries with lower rates of household connection. Water prices in the informal market are much higher than for households with private connections or yard taps.

Although standpipes are heavily subsidized by utilities, the prices charged by standpipe operators are closely related to the informal water reseller price. Standpipe management models also affect the informal price of water. For example, the shift from utilities management to delegated management models without complementary regulation or consumer information has often led to declines in service levels and increased prices. Standpipes are not the only or even the most efficient solution in peri-urban areas. Programs that promote private household connections and arrangements that improve pricing and services in the household resale market should also be considered by policy makers.

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Peri-urban dynamics in Africa: Implications for building healthy cities

August 18, 2010 Leave a comment

Journal of African Studies and Development Vol. 2 (2) pp. 015-026 March, 2010

Peri-urban dynamics and regional planning in Africa: Implications for building healthy cities

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Innocent Chirisa. Department of Rural and Urban Planning, University of Zimbabwe.
E-mail:  innocent.chirisa@gmail.com

Much as peri-urban zones in Africa are places of possible disaster outbreaks in terms of disease outbreaks and other social hazards due to their general lack of planning and institutional integration, they can act as cradles for building health cities. This is so for many practical reasons poised in the sustainable development framework – the prevalence of horticultural activities; their attractiveness to investment by the moneyed classes of society in the areas of housing, commerce and other big-time ventures; and attention by regional planners in their quest for tapping on the wealth of the rural-urban linkages. This article captures these various dynamic activities and developments in the peri-urban zones of some African countries towards building a case for building healthy cities in the sustainable development framework. The key questions addressed in the article are:

  • (a) To what extent are Africa peri-urban zones areas of possible disease outbreaks owing to the increased migration trends in different countries?
  • (b) What regional planning measures to be put in place so that the sustainability of peri-urban areas of the selected cities and towns to curb incidences of waterborne, airborne and other pandemic diseases?
  • (c) What housing options must be put in place towards addressing the slum conditions in these quintessential areas? (d) What is the contribution of developers and investors in the place making of peri-urban settlements?

In addressing these questions, the comparison of the different factors are key in determining whether or not the question of spatial scale matter; technologies to be employed and how best a stewardship approach will help in consensus-building by the different stakeholders so that harmonious places in the form of healthy and stable peri-urban African settlements are fostered. The case study approach was chosen in order to depict spatially  relevant details and dynamics that link the subject of peri-urban interfaces and their implications for regional planning in Africa.

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Experience with water standposts and the informal water sector

August 4, 2010 Leave a comment

World Bank – Provision of water to the poor in Africa : experience with water standposts and the informal water sector, 2010

Full-text:  http://go.worldbank.org/KP718MWHO0

Standpipes that dispense water from utilities are the most common alternatives to piped water connections for poor customers in the cities of Sub-Saharan Africa. Fifty-five percent of the unconnected urban population relies on standpipes as their first water source. Other informal water providers include household resellers and a variety of water tankers and vendors, which are the first water source of 1 percent and 3 percent of the urban population, respectively.

In the cities studied, the percentage of unconnected households ranges from 12 percent to 86 percent of the population. The percentage of unconnected people covered by standpipes is substantially higher for countries with higher rates of household connection, while the percentage of unconnected people covered by water tankers or water vendors is higher for countries with lower rates of household connection. Water prices in the informal market are much higher than for households with private connections or yard taps.

Although standpipes are heavily subsidized by utilities, the prices charged by standpipe operators are closely related to the informal water reseller price. Standpipe management models also affect the informal price of water. For example, the shift from utilities management to delegated management models without complementary regulation or consumer information has often led to declines in service levels and increased prices. Standpipes are not the only or even the most efficient solution in peri-urban areas. Programs that promote private household connections and arrangements that improve pricing and services in the household resale market should also be considered by policy makers.

Categories: Africa Tags: ,

Jhpiego – Urban health in Africa

February 12, 2010 Leave a comment

Jhpiego has implemented two large programs in the slums of Nairobi, Kenya in the past several years and is a founding member of the Nairobi Urban Health Poverty Partnership, a collaborative effort designed to demonstrate the variety of interventions that must be addressed to foster sustainable improvements to health in urban slums. 

With support from the Rockefeller Foundation (2005-2007) and the Wallace Global Fund (2006-2008) Jhpiego has created a sustainable model that links empowered communities with strengthened health facilities.

Examples of the sustainable successes that Jhpiego has spearheaded in the slums include:

  • Peer Education
  • Ongoing Support Groups
  • Community Mapping

Through its Nairobi programs, slums assessments in other parts of Africa, as well as its technical expertise, Jhpiego is looking expand its urban programming to other slums in Kenya and worldwide. Jhpiego has shown that targeted amounts of funding can make a huge impact.

Jhpiego website – http://www.jhpiego.org/whatwedo/urbanslums.htm

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