Water for cities: Responding to the urban challenge
Access to safe water and sanitation is the daily battle for the dwellers living in rapidly growing cities, especially in slums. Dhaka, one of the world’s fastest growing mega-cities is facing abysmal challenges to ensure the right to safe water and sanitation for its people. Experts urged to fill the fissures in the water management plan to cope with the growing number of population and meet the target of Millennium Development Goals.
One out of four city residents worldwide, 789 million in total, lives without access to improved sanitation facilities and 497 million people in cities rely on shared sanitation. The poor in cities receive the worst services, paying up to 50 times more per litre of water than their richer neighbours because they usually have to buy their water from private vendors.
In order to focus the international attention on the impact of rapid urbanisation, industrialisation and uncertainties on urban water systems, World Water Day will be observed tomorrow. This year’s theme, “Water for cities: Responding to the urban challenge” aims to spotlight and encourage governments, organisations, communities and individuals to actively engage in addressing the defy of urban water management.
Slums dwellers, 30 to 50 percent of total Dhaka residents are continuously facing hurdles to access safe water and proper sanitation. The situation is getting more complicated by consistent burden of the new migrants who arrive every day. Nearly 40 percent of world’s urban expansion is growing slums that threatens outbreak of diseases like Cholera, Diarrheoa, Malaria.
Along with existing population, around 2,100 people migrating to Dhaka everyday need potable water, sanitation services, and a wastewater system that keeps the city free of disease and ensures sustainable development. Governments, policymakers, municipalities and civil society need top work harder and plan better to deal with the ever growing water and sanitation needs of everyone. Water, after all is life and sanitation is dignity.
BMC Public Health. 2010 Nov 2;10(1):663.
Using formative research to develop MNCH programme in urban slums in Bangladesh: experiences from MANOSHI, BRAC.
Ahmed SM, Hossain A, Khan MA, Mridha MK, Alam A, Choudhury N, Sharmin T, Afsana K, Bhuiya A.
Research and Evaluation Division, BRAC 75 Mohakhali, Dhaka 1212, Bangladesh. email@example.com.
BACKGROUND: MANOSHI, an integrated community-based package of essential Maternal, Neonatal and Child Health (MNCH) services is being implemented by BRAC in the urban slums of Bangladesh since 2007. The objective of the formative research done during the inception phase was to understand the context and existing resources available in the slums, to reduce uncertainty about anticipated effects, and develop and refine the intervention components.
The perspectives of clients and unqualified allopathic practitioners on the management of delivery care in urban slums, Dhaka, Bangladesh – a mixed method study
BRAC is implementing a program to improve maternal and newborn health among the urban poor in the slums of Bangladesh (Mansohi), funded by the Bill &Melinda Gates Foundation. Formative research has demonstrated that unqualified allopathic practitioners (UAPs) are commonly assisting home-delivery.
The objective of this study was to explore the role of unqualified allopathic practitioners during home delivery in urban slums of Dhaka.
Methods: This cross-sectional study was conducted between September 2008 and June 2009 in Kamrangirchar slum in Dhaka, Bangladesh, using both qualitative and quantitative research methods. Through a door-to-door household survey, quantitative data were collected from 463 women with a home birth and/or trial of labor at home. We also conducted seven in-depth interviews with the UAPs to explore their practices.
Results: About one-third (32%) of the 463 women interviewed sought delivery care from a UAP. We did not find an association between socio-demographic characteristics and care-seeking from a UAP, except for education of women.
Compared to women with three or more pregnancies, the highest odds ratio was found in the primi-gravidity group [odds ratio (OR): 3.46; 95% confidence interval (CI): 1.65-7.25)], followed by women with two pregnancies (OR: 2.54; 95% CI: 1.36-4.77) to use a UAP. Of women who reported at least one delivery related complication, 45.2% received care from the UAPs. Of 149 cases where the UAP was involved with delivery care, 133 (89.3%) received medicine to start or increase labor with only 6% (9 of 149) referred by a UAP to any health facility. The qualitative findings showed that UAPs provided a variety of medicines to manage excessive bleeding immediately after childbirth.
Conclusion: There is demand among slum women for delivery-related care from UAPs during home births in Bangladesh. Some UAPs’practices are contrary to current World Health Organization recommendations and could be harmful. Programs need to develop interventions to address these practices to improve perinatal care outcomes.
Author: Tasnuva WahedAllisyn MoranMohammad Iqbal
Credits/Source: BMC Pregnancy and Childbirth 2010, 10:50
Participants at a daylong advocacy workshop here on Tuesday emphasized the need for bringing all the poor and distressed women and children in the metropolis under primary healthcare activities for ensuring their sound health.
In this regard, they mentioned that proper management of the primary diseases could be effective tools for managing the secondary and other major diseases side by side with ensuring sound health for all.
The workshop titled “Health Service User Forum Awareness” was organized by the Second Urban Primary Healthcare Project under Local Government Division at Hotel Aristocrat.
Population Services and Training Center (PSTC) has been implementing the project in 10 administrative wards of Rajshahi City Corporation (RCC) with the RCC’s financial and administrative support.
Acting Mayor of RCC Shariful Islam Babu addressed the opening ceremony as the chief guest while Director of the project Abu Bakar Siddiqui as special guest with Chief Executive Officer of RCC Ajaher Ali in the chair.
The chief and the special guests noted that the project could be Implemented successfully with concerted efforts of all quarters and urged upon all including the public representatives to perform their duties with utmost sincerity and honesty to attain the cherished goal.
In address of welcome, Executive Director of PSTC Milon Bikash Pal and Chief Health Officer of RCC Dr Abul Fazal elaborated the project activities and, so far, achievements.
They mentioned that the main thrust of the program is to improve the health of the urban people especially poor women and children by improving access and changing the way in which health services are provided.
Besides, they added that provision of primary healthcare through partnership agreements and behavior change communication and marketing, strengthening urban primary healthcare infrastructure and environmental health, building capacity and policy support for urban primary healthcare and project implementation and operationally relevant research are the major components of the program.
Recent ICDDR,B research revealed the extreme vulnerability of street dwellers in terms of their health needs and health-care seeking behaviours. Street dwellers are people who sleep on streets, railway terminals and platforms, bus stations, parks and open spaces, religious centres, construction sites around graveyards, and other public places. They are malnourished, routinely use illicit drugs and experience violence. There is no health service-delivery mechanism specifically tailored towards this marginalized group of people, as there is for other groups like slum dwellers, non-slum dwellers, and people living in hard-to-reach areas, and street dwellers are rarely accessing general essential healthcare services.
To begin addressing these health needs, ICDDR,B in collaboration with the Ministry of Health and Family Welfare (MOHFW), Dhaka City Corporation (DCC), 2nd Urban Primary Health Care Project (UPHCP), Bangladesh Railway, National Sports Council and non-government organizations launched a project funded by the German Technical Cooperation (GTZ), with the specific aim of developing a mechanism to provide essential healthcare services to urban street dwellers in Bangladesh.
The activities of the project included providing essential healthcare services to urban street dwellers through static and satellite clinics from 6:00 pm to 9:30 pm in three central locations of Dhaka city, with two paramedics (one female and male) providing the service. The locations are Karwan Bazar (static clinic), Kamlapur Railway Station and Mogdha Stadium (satellite clinics). Dhaka City Corporation provided a room at their Karwan Bazaar zone office for organizing the static clinic while Bangladesh Railway and National Sports Council provided suitable space at their premises for organizing satellite clinics.
A package of essential services (same package of HNPSP) is being provided to the street dwellers from the clinics at the evening time when the street dwellers are returning from work. All the components of primary health care are included as the components of essential services, with special focus on general health, reproductive and maternal health, child health, environmental issues, and health education and the service provision are free of cost. Services are being provided to the street dwellers who slept for last one week in the study areas. Patient cards are provided to all the clients so that it becomes easy to keep track in the subsequent visits.
For ensuring quality of services the paramedics were trained by the experts from the primary healthcare programme of MOHFW, Marie Stopes Clinic Society (MSCS) and ICDDR,B following the essential services delivery (ESD) protocol. As the street dwellers are extremely vulnerable groups, special focus were given during training of the paramedics so that they become non-judgmental in providing services to the street dwellers. The paramedics were also oriented on their attitude and motivational aspects for dealing with street dwellers. The activities of the clinics and service providers are being monitored and supervised by study investigators using standard checklist.
The drug sellers of local pharmacies are being utilized to inform street dwellers about availability of services for them through the clinics. Name and addresses of the clinics and type of services available in the two types of clinics have been provided to the drug sellers of the local pharmacies. They are being motivated to inform the street dwellers about availability of services in the clinics and also to motivate the street dwellers to go to the clinics for services. A well decorated rickshaw van is being used for carrying clinic staff and materials and for publicity purposes.
A system of referral linkage has been established from these clinics to nearer health facilities of MSCS, UPHCP and MOHFW. The paramedics refer the cases to these referral points and follow up is being done by a project staff on the cases to know what happened after referral.
Since the beginning of the project, there has been surprisingly a strong demand for services: 45 to 50 patients use the services each day, somehow more than half of the patients are women. The main complains of the patients visiting the clinics included: general health, STI/RTI, ANC, PNC, family planning methods, ARI, diarrhoea, dysentery and immunization.
In order to review and monitor the project activities and to start process about its sustainability a Project Management Committee (PMC) has been formed. The committee consists of the members from Directorate General of Health Services, Dhaka City Corporation, UPHCP, GTZ, Plan International, MSCS, Sajeda Foundation and ICDDR,B. The committee met twice and reviewed the performance of the project activities. Last PMC meeting decided that the committee will meet quarterly to review performance of the project and to guide the project implementation team.
The static and satellite clinics will be compared to each other in terms of their cost and effectiveness. This comparison will enable us to identify the model of choice-which is financially most affordable and programmatically most effective.
It is expected that after implementation of this 18 months project will develop a mechanism to provide essential healthcare services to urban street dwellers in Bangladesh.
Water Sci Technol. 2010;61(6):1515-23.
Acceptability of the rainwater harvesting system to the slum dwellers of Dhaka City.
Islam MM, Chou FN, Kabir MR. Department of Hydraulic and Ocean Engineering, National Cheng Kung University, 1 University Road, Tainan 70101, Chinese Taiwan, China
Urban area like Dhaka City, in Bangladesh, has scarcity of safe drinking water which is one of the prominent basic needs for human kind. This study explored the acceptability of harvested rainwater in a densely populated city like Dhaka, using a simple and low cost technology.
A total of 200 random people from four slums of water-scarce Dhaka City were surveyed to determine the dwellers’ perception on rainwater and its acceptability as a source of drinking water. The questionnaire was aimed at finding the socio-economic condition and the information on family housing, sanitation, health, existing water supply condition, knowledge about rainwater, willingness to accept rainwater as a drinking source etc.
A Yield before Spillage (YBS) model was developed to know the actual rainwater availability and storage conditions which were used to justify the effective tank size. Cost-benefit analysis and feasibility analysis were performed using the survey results and the research findings.
The survey result and overall study found that the low cost rainwater harvesting technique was acceptable to the slum dwellers as a potential alternative source of safe drinking water.
JOHANNESBURG, 23 March 2010 (IRIN) – A lack of clean water and sanitation in burgeoning slums could trigger a complex set of humanitarian crises says a new paper, Urban Catastrophes: The Wat/San Dimension, by the Humanitarian Futures Programme (HFP) of King’s College London, which keeps an eye on possible crises that could emerge in the not too distant future.
Using plausible but fictitious scenarios set in the slums of Dhaka, capital of Bangladesh, and the city of Sao Paulo, Brazil, the paper shows how water scarcity brought on by climate change and large numbers of people in urban areas could lead to water stress, especially in slums, where shortages can stoke conflicts and an outbreak of a new and virulent influenza.
Simultaneously, the new biennial report by UN-HABITAT, the State of the World Cities 2010/2011: Bridging the Urban Divide, notes that around 3.49 billion people – more than half the world’s population – now live in urban areas, of which 827.6 million are slum-dwellers. The global slum population will probably grow by six million each year, pushing the total number to 889 million in another 10 years.
Urbanization can also provoke water-quality problems, leading to outbreaks of waterborne diseases like cholera. An outbreak that began in the slums of Luanda, the Angolan capital, killed over 2,800 people in 2006, when only 66 percent of Angola’s urban population has access to safe drinking water, according to the UN.
Water shortages in slums could open the door to corruption, conflict and an increased risk of disease, setting off a range of complex humanitarian crises. Many of these factors are already evident and operating in slums across the world, the authors of the HFP report note.
“As with any valuable good, the provision of clean water and sanitation facilities in slums is an attractive target for corruption, greed, collusion and exploitation,” the HFP researchers pointed out.
In areas where there is a lack of accountability and political oversight, “resulting in collusion between government officials and private-sector water providers”, slum dwellers have to pay a very high price for water, and sanitation falls by the wayside.
The result is that the civil society is weakened and ability of slum dwellers and external players to change the system and help the residents out of poverty is curtailed, the HFP report commented.
There is also evidence that water shortages threaten increased violence and conflict, especially in “high-density, multi-ethnic, politically unequal environments of concentrated poverty, as is often found in many slums,” the HFP report said, citing reports of water-related protests and conflicts in Bolivia, Pakistan and India.
Risk of disease
As larger numbers of people move into already crowded areas, they are often forced to live in unacceptably poor sanitary conditions, sometimes even at close quarters with animals, giving rise to opportunities for new disease vectors, noted the report. In slums located in tropical climates, the chances of new forms of diseases evolving are high.
What to do
Randolph Kent, who heads HFP, pointed out that the projections were for 20 to 30 years in the future, “but the idea is to provide enough time to countries to plan ahead”.
He suggested setting up low-tech, cheap service delivery systems – for instance, to provide water, use segmented flexible rubber hoses that can be easily connected and disconnected. The hoses are produced by several independent companies, can be serviced and maintained by unskilled technicians, and offer plenty of design options.
For waste removal, the report suggested an improvement on the traditional chamber pot – use antibacterial plastic buckets that can be fitted with mechanically sealing covers, as on commercial compost bins. The bucket can be carried either by hand or taken by cart to a dumping point like a municipal sewer, then cleaned by hand or at a semi-automatic hot water and bleach station, and delivered to the family for re-use.