From 2012 to 2016, IDS and partners in India, South Africa and Kenya have undertaken research on the issues of the health of women and girls living in low-income urban settlements. As part of this research, we held an online discussion, and undertook a Thematic Review, six policy case studies, and a policy briefing paper. As a result, have created a large number of outputs, findings and recommendations, as well as opportunities for uptake. The key recommendations from our work are outlined below, with links out to the source output for further reading. [Download Policy briefing (PDF 191 Kb)]
- The thematic review and a number of case studies, specifically the case study on NCDs in South Africa, found that it is essential to take a multi-sectoral approach, and there is a need to involve community leaders to ensure buy-in. Similarly, the case study on ICTs and sexual and reproductive health and rights in South Africa highlights the need to encourage ICT for health integration into existing health systems and programmes, rather than stand-alone projects and innovations.
- The case study looking at maternal mental health in South Africa found that specialist interventions for maternal depression are likely to be too expensive for many lower and middle income countries (LMIC). It therefore recommended that evidence is needed for how specifically targeted interventions for moderate to severe depression can be integrated into primary health care and other delivery platforms.
- In Majengo and Kibera, Nairobi, it was found that women and girls face both internal and external barriers to political participation through not knowing how political systems work, a lack of confidence and knowledge about how to engage policymakers, a lack of time and income and other competing priorities. The case study on access to HIV services in Kenya therefore recommends establishing initiatives to enhance the participation of poor women and girls in the political arena, and recognise the broader internal and external barriers that prevent participation.
- The case study on ICTs and sexual and reproductive health and rights in South Africa highlighted that it is important to pay careful attention, coupled with impartial research, to the role of the private sector when partnering with government; with particular consideration of regulation, vested interests, technical expertise, framing content and political influence.
- In Maghalaya, India, annual targets for health indicators (set by the state) are developed based in indicators from national-level data that often represent much larger states that differ socially, culturally and politically. The case study on sexual and reproductive health and rights in an indigenous context in India recommends funding and improving research at sub-national/local levels on gender, governance and health to inform policy and programme decisions.
- In Khasi society in Maghalaya, India, women are excluded from political participation on many levels. The case study on sexual and reproductive health and rights in an indigenous context in India call for the facilitation and improvement of a transparent civil participation processes that engages with men and women as recommended in the National Urban Health Mission (NUHM).
- In a Case Study on the impact of community-led total sanitation on women’s health in urban slums in the Kalyani Municipality, reserachers seek to understand the health and other impacts of slum women’s access to sanitation through the Community-led Total Sanitation (CLTS) approach. The benefits of CLTS to the community were not limited to changed sanitation behaviour and an end of open defecation – there were significant development and health gains beyond sanitation.
Cross-cutting Policy Findings and Recommendations:
In order to identify cross-cutting policy findings and recommendations from the four years of research, we developed a policy briefing. You can find out more about the four identified cross-cutting themes and their associated polciy recommendations in the pages below:
Intra-urban health inequalities
The majority of the world’s population now reside in cities and this trend is set to continue. City living can provide opportunities, and in some countries, people living in urban areas experience better health, on average, compared to those in rural areas. However, this average masks the marked inequality that exists within urban areas, perpetuated by underlying political, economic and social factors. Read more...
Barriers to access of health services
Life for women and girls living in low-income urban settlements is characterised by exclusion, and this is reflected in poor access to basic health care and services. The thematic review and several case studies observed women’s poor access to appropriate, efficient and confidential health services. Read more...
Community, voice and participation
Voice, participation and community engagement are essential to ensuring delivery of appropriate and effective health services for women and girls in low-income urban settlements. There are numerous examples from the case studies where participatory engagement has been integral to improving health services and delivery. Read more...
Taking a multi-sectoral approach
ll-health is just one of the challenges poor women and girls face in low-income urban settlements, alongside many other social, economic and structural determinants of health. Findings from the thematic review and several of the case studies stress the need for a more cohesive approach, bringing together multiple sectors. Read more...