Tackling Health Challenges for the Urban Poor
Half of the global population live in urban settings and yet, despite the economic growth, social advancement and innovations so commonly associated with cities, they are also places of vast health inequities, inadequate housing and transport, low hygiene and sanitation, and poor air quality. These issues are most acutely felt in informal settlements, where 60% of Nairobi’s population live. While urban populations everywhere continue to sharply rise, healthcare systems - including infrastructure, professionals, facilities, and services - are not keeping pace.
As part of an USAID Health Research Program webinar series, Jacaranda’s Research Manager Deborah Sambu, and Executive Director Sathy Rajasekharan, shared learnings from an ongoing urban health project - Kuboresha Afya Mitaani, or KAM - and how it is leveraging implementation research to tackle health challenges for the urban poor. The project, launched in 2019 with support from USAID, aims to drive better health outcomes for 60,000 of Nairobi’s most vulnerable women and children, and catalyze political interest for future innovations in other urban settings.
What we learnt…
A successful urban health project is built on multi-stakeholder engagement …Informal settlements - by nature of their name - are made up of a complex web of stakeholders, including diverse individuals, communities, health providers and regulators, as well as other sectors. For urban health projects to be successful, they need to actively bring together these typically siloed actors in health to collaboratively address local challenges, and develop solutions that are mutually beneficial to each.
Abandoning top-down approaches helps identify specific challenges and build future sustainability... While many health projects are planned and implemented through government collaboration, a top-down approach is less effective in informal settings where there is a flatter hierarchy and many community leaders. Engaging community voices - and doing this early - is a critical part of pin-pointing why and where certain health challenges exist. By making communities not only beneficiaries, but also facilitators in a project’s development, you ensure it has a relevant use case for the future.
Agility and flexibility is key to the planning and implementation of urban health projects...Informal settlements are unstable places, with ever-changing conditions and transient populations. COVID-19 has had an acute impact on these settings, further compromising unregulated and fragmented health services. Urban health planning and programming needs to be designed to quickly adjust based on what is going on on the ground, and adapt to the changing needs of the populations it serves.
Implementation Research helps understand the drivers of poor health, but it isn’t a one size fits all…. Successful implementation research fully embraces contextual factors by drilling into the why, how, what, and where of health system challenges. Therefore, what might work in one setting, mightn’t work in another. By taking a participatory approach to understand the social, cultural, economic, political, and physical environment you’re working in, you lay stronger foundations for effective implementation.