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Treat, contain, repeat: key links between water supply, sanitation and urban health

PascaleHofmann14 January 2019

This blog is the third of the health in urban development blog series. View also:

Health in secondary urban centres: Insights from Karonga, Malawi
By Don Brown

Gaza: Cage Politics, Violence and Health
By Haim Yacobi

If you are interested in DPU’s new MSc in Health in Urban Development, more information can be found on our website.

 

In Dar es Salaam, Tanzania’s main economic and administrative centre, high population densities, the accumulation of informal lower-income residents, lack of access to clean water and poor sanitary conditions have been associated with a range of water and sanitation-related diseases. Cholera outbreaks are a frequent occurrence during the rainy season and some settlements in the city are among the worst affected in the country. In this context, I argue that urban water poverty needs to be tackled using a proactive rather than reactive approach at the local level to yield long-lasting health benefits.

Main access road in an informal settlement in Dar es Salaam after an episode of heavy rainfall (Photo © P. Hofmann, 2015)

 

Tackling urban water poverty and community health promotion

Internationally, the link between urban water poverty – i.e. inadequate access to water supply and sanitation facilities, and public health – is widely recognised whereby improvements in accessing water and sanitation are deemed crucial in tackling a diverse range of diseases and improving the lives of the poor.

Such thinking calls for integrated and consistent approaches, which, as emphasised by a UNICEF WASH specialist in Tanzania are evidently lacking in most policy-driven practices on the ground.

“Hygiene and sanitation awareness, behaviour change, communication and empowerment are maybe done in urban areas but erratically, not systematically. When the rains are coming and there is threat of cholera etc. then you will find people will announce:  ‘food vendors cover properly your food and make sure it is hot and whatever, please clean your surroundings, no solid waste should be seen and liquid waste, please drain it out completely’ etc. […] or there is a cholera outbreak in a certain locality in Dar es Salaam and it is feared that it might spread, so that happens but on a regular basis there is not a lot done” (quote from UNICEF WASH specialist).

During the recent cholera outbreak in 2015 government spending increased significantly to treat the affected population. While curative measures are vital, efforts to improve water supply and sanitation constitute essential steps towards future outbreaks. Similarly, some municipalities in Dar es Salaam have put continuous support into household fumigation programmes to impede the spread of malaria but fall short of investing in preventative measures to keep people healthy – i.e. reduce mosquito breeding sites through the provision of safe drinking water, improved sanitation and hygiene. Currently, the onus is predominantly on residents themselves to be pre-emptive in their everyday practices with regards to potential health implications but not everybody is equally aware or shares the same ability to act. In the absence of sufficient government action, those who can have invested in better access to water, improved sanitation facilities and even flood defences.

Drainage channel built by two neighbouring households to divert water from the Msimbazi river, which carries wastewater from nearby wastewater stabilisation ponds (Photo © P. Hofmann, 2015)

 

“In 2011 there was flooding and we lost our livestock and we had to start afresh. What actually happened is there has been increased silt in the Msimbazi river. At the same time, there is wastewater that comes from the ponds and where these meet, that impact pushes the water towards our land. […] we constructed this drainage channel jointly with my neighbour after the flooding to try and divert the water from coming in” (quote from a resident in an informal settlement in Dar es Salaam).

The need for a proactive, decentralised approach

Ward health officers are officially tasked with preventing water-related diseases and promoting environmental health in their jurisdiction through regular water quality tests at local water supply schemes and inspections of businesses and households with no equivalent paid staff at sub-ward level. However, with limited resources at ward level much of the action regarding water supply, sanitation and environmental health depends on voluntary efforts in the communities by residents themselves and facilitated through sub-ward committees, water committees and community representatives. Many health officers at the ward level understand the importance of sanitation, drainage and safely-managed water supply but struggle to influence the agenda at higher levels of government. The Decentralisation by Devolution Policy introduced in the 1990s transferred responsibilities to local government for service improvements but without fiscal decentralisation or devolution of decision-making power. Decentralisation should pave the way for bottom-up participatory planning processes but municipalities in Dar es Salaam focus on central government priorities while continuing to disregard lower levels of government and their efforts to address local challenges. Decentralised decision-making structures are therefore not a guarantee for more democratic processes.

The importance of engaging urban poor communities

To lower the burden of water and sanitation-related diseases, engagement of communities with the authorities (utility and municipal government) is crucial but often limited and slow. Until recently, one of Dar es Salaam’s municipalities prohibited low-income communities living near wastewater stabilisation ponds to use them for safe sewage disposal. A lengthy period of continuous interaction between the local community, the municipality and the utility, facilitated by a local NGO, eventually led to a pilot initiative that connects household toilets to the nearby ponds using simplified technology. This has reduced the number of pits being informally emptied during the rainy season and led to a safer and healthier environment for residents.

Inspection chambers of the simplified sewerage pilot in an informal settlement of Dar es Salaam (Photo © P. Hofmann, 2015)

The utility seems keen to replicate the scheme elsewhere in the city, which shows potential that policy-driven practices can be transformed, scaled up and institutionalised in ways that are more integrated and sensitive towards the needs of the urban poor if sufficient consideration is given to the scope for scaling up and sharing the benefits more equally within a settlement.

 

Pascale is a Lecturer at the Development Planning Unit, UCL, where she leads the MSc in Environment and Sustainable Development Programme. Her current research is particularly concerned with the dialectics of urban water poverty, examining different policy-driven and everyday practices and their impact on everyday trajectories of the urban water poor. She is interested in generating knowledge towards developing feasible pathways out of urban water poverty.

Exploring possibilities for community-led urban land development in Dar es Salaam

RafaellaSimas Lima19 May 2015

For the past two-weeks students of the MSc Urban Development Planning have been working in three sites across Dar es Salaam, Tanzania, as part of their field trip project supporting community-based initiatives for informal settlement upgrading.

Working with the Center for Community Initiatives (CCI), a local NGO, and members of the Tanzanian Federation of the Urban Poor, students have been trying to understand the realities of urban life in these three areas while developing ideas to guide more socio-environmentally just trajectories of urban development at the city-wide scale.

Incomplete houses on the Chamazi site Image: Rafaella Lima

Incomplete houses on the Chamazi site
Image: Rafaella Lima

The three sites in which the groups are based—Karakata, Chamazi, and Mabwepande—have much in common: they are all growing peri-urban areas, they are all mostly “informal” or “unplanned”, most residents are low-income, and they face similar interlinking challenges such as infrastructure, access to basic services, sanitation, and solid waste disposal. But they also represent different patterns of land acquisition and development within the Tanzanian context.

Learning about the Gulper machine, a mechanism that the Federation has been using for the emptying of pit latrines in Karakata.

Learning about the Gulper machine, a mechanism that the Federation has been using for the emptying of pit latrines in Karakata.

Karakata is the longest-established settlement of the three, and developed as residents from elsewhere in the city moved further out in search of more affordable land and rent prices. Considering Karakata’s close proximity to Julius Nyerere International Airport, as well as its diverse array of livelihood activities, the value of the land is currently rising at a rapid rate.

Residents face big issues such as sanitation and access to medical services, and the rapid erosion of the river in the area presents a grave environmental threat. Students assigned to this site have been working on ideas such as community-led environmental risk assessments and a more sustainable model for the Federation’s waste-disposal system.

Mapping the route between Chamazi housing site and the town centre.

Mapping the route between Chamazi housing site and the town centre.

In Chamazi, Federation members formed a housing cooperative to collectively purchase a plot of land to build homes for those who were evicted by the government from Kurasini Ward in 2008, due to the expansion of the port area.

However, since the project began in 2009, many houses have not been completed and a high percentage of families have yet to move to the site. One hypothesis for this has been that Chamazi’s distance from the city center (sometimes 3-4 hours with traffic) means much fewer livelihood and employment opportunities.

But the Chamazi site is not as isolated as it once was; in only the past few years the area around Chamazi town has grown rapidly, bringing new businesses, markets and services. UDP students have been exploring the seeming disconnect between the housing site and the town, along with the financing of the housing project to understand how it can remain affordable and viable.

A student-led focus group trying to understand the dominant challenges in Mabwepande.

A student-led focus group trying to understand the dominant challenges in Mabwepande.

Mabwepande is another peri-urban site for relocated people, however in this case the government allocated land for victims of flooding in the more central Suna zone.

At the moment the area feels rural and many residents use the non built-up space for agricultural purposes, but we have yet to see how increased development of the area and new pressures on land will affect them.

As the Federation has only just begun working in this site, Mabwepande had yet to be mapped in a way that was accessible to its residents. Along with conducting interviews and focus groups to begin to build a larger picture of the Mabwepande community, students created maps with the help of community members to be shared on the site.

Students present some of their findings and ideas to community members in Karakata.

Students present some of their findings and ideas to community members in Karakata.

These three sites are illuminating important citywide processes, such as the uncertain institutional relationships that govern the urban poor’s access to land (for example, there is no clear resettlement policy that might guide the relocation of people like in Chamazi and Mabwepande).

Students are understanding the notion of “scale” in practice, as they come to grips with the scale of informality and poverty across Dar es Salaam. This has been underpinned by the rainy season, in which intense flooding across the city has brought the hardships faced by Dar’s poorer residents into clear focus.

Observing a Federation and CCI-led focus group used in settlement profiling in Vingunguti settlement.

Observing a Federation and CCI-led focus group used in settlement profiling in Vingunguti settlement.

Finally, there is the challenge of gathering reliable data in a city that is growing so rapidly, in a context where certain forms of knowledge are not recognized. The field trip focuses on the way knowledge is built at the local level as students learn from the Federation model of settlement profiling, enumeration, and mapping.

In return, students offer input and experiences from their diverse home countries to try and support community-led processes of co-production of housing, land development, and knowledge.

Sanitation and the Politics of Recognition in Kibera

TamlynMonson6 May 2015

To kick off their field trip to Kenya, students on the MSc Social Development Practice spent much of the day with representatives of Practical Action and Umande Trust, hearing about the ways in which these organisations have worked with local residents to promote productive and liveable settlements in Kenya’s slums.

Part of the day’s programme was a trip to Gatwekera in Kibera, Nairobi, where we visited two of the settlement’s 16 biocentres. The biocentres provide accessible toilets, where – in an awesome reframing – excreta becomes a ‘human investment’ that is collected in a biodigester to produce gas for cooking and slurry that can be put to agricultural use.

Street view from Gatwekera Total Sanitation and Hygiene Access (TOSHA) network biocentre. Image credit:  Tamlyn Monson

Street view from Gatwekera Total Sanitation and Hygiene Access (TOSHA) network biocentre. Image credit: Tamlyn Monson

Our objective was to understand whether and how these infrastructure projects could help us identify avenues through which such projects can be scaled up to more explicitly political claim making around citizenship. However, the reality of the interventions exposed some of our received assumptions about how such claim making should proceed.

For instance, we found that in advocating for the rights of informal settlement residents, NGOs may also face certain informal political dynamics at higher scales within the state, and therefore opt to advocate for change outside of the ‘direct’, formal channels.

According to Peter Murigi of Practical Action, completed infrastructural investments have the potential to legitimise the claims of informal residents to improved living conditions, this is because in permitting these interventions the state has indirectly recognized the need for change. Rather than explicitly lobbying through formal channels for change, advocates can use these achievements as precedents justifying claims for further practical improvements when opportunities to indirectly influence power holders arise.

Multi-level biocentre in a Kenyan informal settlement. Image credit: Umande Trust

Multi-level biocentre in a Kenyan informal settlement. Image credit: Umande Trust

Witnessing the significant achievements of the Gatwekera Total Sanitation and Hygiene Access (TOSHA) Network, both staff and students were struck by the limited role of the state in these achievements: the government’s contribution, according to the TOSHA chairperson Moses Ambasa, is merely to “allow us” to go ahead – with projects realized through donor funding and community labour only.

Ambasa was satisfied with this situation, in which slum dwellers are, so to speak, permitted to solve ‘their own’ problems. Participants felt a tension between the need to give due weight to this community voice, and the need to challenge the idea that residents of slums should shoulder such a disproportionate burden of cost and responsibility in securing basic living conditions.

In an afternoon debrief, students acknowledged various shifts of perception inspired by the visit to Kibera, which exposed many to the complexity and ambiguity of an informal settlement for the first time. This was an exciting and stimulating start to a field trip in which students will soon be entering an unfamiliar field in the secondary city of Kisumu. The reflexive trajectories opened up today will be a valuable asset as students soon begin a practical engagement with the Kisumu Informal Settlements Network (KISN). They will be entering the field well prepared to begin unpacking the various entanglements we always find there.


Tamlyn Monson is the Graduate Teaching Assistant for the MSc Social Development Practice at the DPU and a PhD candidate at the LSE. Staff and students on the MSc SDP programme engage in overseas research with Practical Action in Kenya each year – read about the collaboration on the DPU website.

Gender and sanitation: the hidden issue of gender-based violence

ChristopherYap11 March 2015

Trucks depositing liquid waste operate on the edge of the Kombo Ward in Dar es Salaam, Tanzania. Image: Adriana Allen

Trucks depositing liquid waste operate on the edge of the Vingunguti settlement in Dar es Salaam, Tanzania. Image: Adriana Allen

Access to safe, dignified and appropriate toilets and sanitation facilities is a basic right for women, men, boys and girls worldwide. However an estimated 2.5 billion people still do not have access to adequate sanitation facilities globally. This issue is most prevalent in the Global South, and in urban contexts a lack of appropriate sanitation facilities is a particular, commonplace condition of informal and unplanned settlements.

Sanitation in informal settlements

Lack of access to appropriate sanitation facilities is closely related to the complex reality of insecure living conditions facing informal urban inhabitants. Those living in ‘slums’ are often denied access to formal infrastructure due to their insecure tenure and livelihoods, and marginalised status within the city.

As a result, these citizens are forced to develop their own infrastructures for toilets and sanitation. Each solution, including communal, privately funded facilities, and pit latrines, comes with its own assemblage of risk, be it health or hygiene-related, environmental or social, or a combination of these.

The vast majority of toilets and sanitation facilities in informal settlements exist not in private homes, but in public spaces. The nature and degree of risk associated with these spaces reflects the broader social relations of power in the community. Central to this inequitable distribution of risk is the issue of gender inequality.

Image: Adriana Allen

Image: Adriana Allen

Gendered differences in use of public space

In many patriarchal societies, a public/private space dichotomy exists by which women’s access to public space is more restricted than men’s. Women’s mobility is restricted due to both time constraints associated with reproductive roles as well as ‘symbolic dimensions surrounding the ‘forbidden’ and ‘permitted’ use of spaces governed by patriarchal power relations and norms of female propriety.’ [1]

Gender-based violence is an expression of these unequal gender relations. It exists in a variety of forms, from physical abuse, assault and rape, to verbal insults and psychological trauma.

In this sense it might be understood as a response to perceived infractions of gendered ideologies (such as women moving freely in public spaces or earning more in a household than men). While the vast majority of gender-based violence is perpetrated by men against women, men and boys can also be victims. In Mumbai, for example, the practice of ‘eve-teasing’ is commonplace, with men targeting women with obscenities and in some instances throwing stones.

Women adapt to avoid risks – but where does the problem lie?

In informal settlements, women are often at greater risk of gender-based violence due to the lack of effective policing, and lack of access to formal recourse mechanisms, including the justice system itself. In many cases the onus is on women to alter their behaviour in order to avoid risk, rather than the perpetrators.

For example: WaterAid found that 94% of women they surveyed in Bhopal, India faced violence and harassment when going to defecate, and a third had been physically assaulted [2]. Communal toilets are often built near the peripheries of settlements, meaning that women are more vulnerable to assault, particularly at night and in areas with little or no public lighting.

The facilities themselves can be poorly maintained, unhygienic and lack privacy for women. These conditions drive the practice of open defecation in settlements, which increases the health risks to the community and further exposes women to violence amongst other risks.

The association between gender-based violence and toilet and sanitation facilities in informal settlements is only one manifestation of citywide injustices relating to gender, class, caste, and identity amongst others. Lack of access to adequate toilet and sanitation services can lead to an increased vulnerability to gender based violence in different forms.

Vingunguti in Dar es Salaam, Tanzania. Image: Pascale Hofmann

Vingunguti in Dar es Salaam, Tanzania. Image: Pascale Hofmann

A right to safe and secure sanitation

Focusing on this issue makes it possible to identify ways of improving the everyday safety and well-being of women in informal settlements through better design and management of facilities. It also has the potential to confront the gendered ideologies driving the reproduction of risk and violence in informal settlements.

We must grasp the urgency of taking action to combat the disproportionately hostile experiences facing many women when accessing sanitation, particularly in informal settlements.

The realisation of the right to sanitation is a necessary but insufficient step towards addressing gendered inequalities, not least the elimination of violence against women. But it is only by recognising the daily challenges facing women around the world that we can begin to address them.

 

Indefensible Space: Gender based violence and sanitation in informal settlements

is a Project implemented by the DPU and the Institute of Child Health, UCL, and SNEHA, Mumbai and supported by the Institute for Global Health/UCL Grand Challenges.

On Tuesday 24th March practitioners and academics will host a half day Colloquium exploring the issues relating to gender-based violence facing women in slums; there will be a first London screening of a participatory film produced with slum communities in Dharavi, Mumbai as part of the Project. Read more about the project and book your place in the audience today.


Notes:

  1. Chant, S. and McIlwaine, C. (2013). “Gender, Urban Development and the Politics of Space”, 4 June 2013.
  2. WaterAid and National Confederation of Dalit Organisations (2013). Research on the DFID-supported IPAP programme in India in five states (unpublished).

Chris Yap is the Graduate Teaching Assistant for the MSc Urban Development Planning. He has worked with a number of organisations including the International Institute of Environment and Development, London International Development Centre, Pastoral and Environmental Network in the Horn of Africa, and Oxfam America on topics including the Post-2015 Sustainable Development Agenda, communal and collective land tenure options for low income groups, participatory budgeting in a post-disaster context, community led-mapping and urban agriculture.