Inclusive Urbanisation and Cities in the Twenty-First CenturyIDS Evidence Report, 2017In academic and policy discourse, urbanisation and cities are currently receiving a great deal of attention, and rightly so. Both have been central to the enormous transformation the world has been going through during the past few centuries. Many parts of the world have experienced and are experiencing an urban transformation. While these processes have taken distinct regional forms across Latin America, East and South Asia, and Africa, it is clear that, globally, the urban transformation has coincided with major societal and ecological changes. Some of these developments have been heralded as progress – notably millions of people being lifted out of poverty – while others, such as entrenching inequalities and accelerating climate change, are alarming. In recent years the pro-urban voices have been louder, but accounts of the wonders of cities need to be balanced with a recognition of the violence, inequity and environmentally destructive forces that cities can embody and reproduce. Equally important is to explore how cities and urbanisation can be made to contribute more to human wellbeing and to international and local development goals. This report is particularly concerned with whether and under what conditions more inclusive urbanisation and cities can support these development goals.
Creating Safe and Inclusive Cities that Leave No One BehindIDS Policy Briefing, 2016Half of humanity now lives in urban areas, and a growing number of cities are leading the way in generating global GDP. However, cities have increasingly become key loci of violence over the last 50 years, which particularly affects the most marginalised. Creating safe cities which adhere to the principles of the New Urban Agenda will require fostering urban safety through inclusive policies and practices that secure, but do not securitise, urban spaces. This involves using innovative measures to accurately understand people’s vulnerabilities, supporting evidence-gathering from small and medium-sized towns alongside larger cities, and analysing safe and resilient urban spaces alongside more fragile ones.
Impact of Community-led Total Sanitation on Women’s Health in Urban Slums: A Case Study from Kalyani MunicipalityIDS Evidence Report, 2016This Evidence Report seeks to understand the health and other impacts of slum women’s access to sanitation through the Community-led Total Sanitation (CLTS) approach. It also examines the process through which open defecation free (ODF) status was attained in two different slum colonies, the resulting health impacts and the collective action that took place around both sanitation and other development benefits. The study was conducted in the slums of Kalyani, a Municipality town located 55km north of Kolkata, the capital city of West Bengal state in India. From an area plagued with rampant open defecation, the slums of Kalyani were transformed into the first ODF town in India in 2009. This was achieved through the CLTS model that focused on motivating the community to undertake collective behaviour change to achieve ‘total’ sanitation and an ODF environment. This was in sharp contrast to earlier, top-down approaches to the provision of toilets, which had failed to ensure ownership or usage by the community. 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. Women’s health in this study has been viewed not just in terms of the presence or absence of disease burden on the physical health of women but also in terms of their socio-psychological wellbeing resulting from reduced risks and a wide range of benefits accruing from better sanitation and hygiene practices and facilities. The study also focused on exploring the extent to which the CLTS process can be said to have empowered women. As experiences of good health and wellbeing are affected by factors in the external environment, namely the role of the local government, women’s access to health services and the involvement of multiple sectors, these issues were also considered, in order to understand the overall health status and experiences of women in Kalyani slums.
Constitutional Reforms and Access to HIV Services for Women in Low-resource Settings in Nairobi, KenyaIDS Evidence Report, 2015After more than two decades of agitation for a new constitution, the violence that followed Kenya’s 2007 presidential elections finally led to a reform movement to overhaul the way the country was governed. On 4 August 2010, voters approved a new Constitution by a clear majority, reflecting a widespread desire for change. The aim was to improve government accountability and democracy by reorganising the government. There are now more checks and balances, parliamentary oversight of the executive is stronger, and the Bill of Rights provides greater protection for citizens, including women and minorities. Perhaps the most profound change is devolution: the transfer of power from the centre to regional authorities. In the case of Kenya, devolution has meant granting statutory powers to the counties. The devolution of health services began in 2013 with the election of governors and county principals. Devolution potentially has wide-ranging implications for Kenya’s health sector, which is already failing on several levels. In Kenya, the prevalence of the human immunodeficiency virus (HIV) slowed from between 13 per cent and 15 per cent of the general population in 1999 to 5.6 per cent in 2012. Nevertheless, this is still one of the highest rates of HIV infection in the world. Women in Kenya have been disproportionately affected by HIV. Four years after the approval of the new Constitution, this case study examines: the difficulties that poor women and girls living in slum areas face in getting access to HIV services, including anti-retroviral treatment (ART); their perception of how devolution has affected HIV and other health-related services; and their ability to participate in political decision-making and to bring about change at the local level. Are HIV-positive women and girls in slums able to get the attention of policymakers at the county level in order to get the services they need?
When the Hen Crows: Obstacles that Prevent Indigenous Women from Influencing Health-care Policies – A Case Study of Shillong, Meghalaya, IndiaIDS Evidence Report, 2015Meghalaya is a landlocked and largely agrarian state in northeast India with an approximate population of three million. Various government surveys report that roughly half the state lives below the poverty line. Most people live in rural areas, but in recent years Meghalaya has experienced rapid population growth and urbanisation: between 2001 and 2011, Meghalaya’s cities grew 20 per cent. This has put increasing pressure on urban areas. Today, one out of five people in the capital of Shillong are slum dwellers. Meghalaya is part of India’s ‘tribal belt’, with a predominantly indigenous population (86 per cent), of which the Khasi constitute slightly more than half. The Khasi are one of the largest matrilineal cultures in the world, with distinct political institutions that coexist alongside India’s modern state system. Identities in the indigenous group are closely linked with maternal lineage: the children take the name of their mother’s clan, and traditionally, the youngest daughter in a family inherits the ancestral land of her family. Despite living in a matrilineal society, when it comes to health and education, women in Meghalaya lag behind their peers in other northeastern states. The state has some of the worst maternal health indices and the highest unmet contraceptive need in India. One of the reasons for the women’s low status is the position of Khasi women in their communities – they do not participate in traditional political decision-making, which historically is a male domain. Khasi women are barred from even attending decision-making processes. There is an old saying among Khasis: ‘Ynda kynih ka ‘iar kynthei, la wai ka pyrthei’ or ‘When the hen crows the world is coming to an end.’ It is taken to mean that if women take part in politics, the world is doomed. This paper examines how the Indian state prioritises health needs, and how and whether poor and indigenous women are able to participate in decisions about their sexual and reproductive health. The focus is on the indigenous Khasi population in Meghalaya, with its traditional systems of governance that exist in tandem with India’s modern institutions. Literature and document reviews, documented participation through interviews and focus group discussions at these different levels in Shillong help explain what opportunities and barriers women have for political participation.
Sexual and Reproductive Health Rights and Information and Communications Technologies: A Policy Review and Case Study from South AfricaIDS Evidence Report, 2015This report explores the intersection between sexual and reproductive health (SRH) and technological means of enhancing health. South Africa has a high teenage pregnancy rate. Almost a third of its girl teenagers report having been pregnant. The drivers of teenage pregnancy include uneven gender relations, poor access to health services and a lack of knowledge about sexual reproduction, contraception and poverty. Poverty and place of residence also affect pregnancy and health outcomes. Women and girls living in low-income residential areas have little or no access to comprehensive sexual and reproductive health services, including sexual, reproductive and maternal health. Women and girls located in rural, peri-urban and informal settlement contexts also experience technology deficits, including low levels of mobile phone ownership, poor network coverage, weak satellite signals and insufficient bandwidth. At present, very little research explores health within peri-urban contexts and the interconnections between poverty, place and health. At the same time, e- and m-health, and the information and communications technologies (ICT) that they rely on are frequently seen as a panacea to struggling health systems and as a means of meeting the health needs of women and girls in hard-to-reach places. Yet many complex factors are required for a successful m-health intervention. These include appropriate policy recognition from both the Department of Health and the Department of Communications; cooperation between the government and the private sector to bring together professional expertise (in health and technology); financial resources; awareness of women’s and girls’ sexual and reproductive health needs and rights; planning and provision of health information; consideration of ethical information and privacy; and awareness of the potential for such systems to generate savings and/or additional revenue. Using ICT (particularly mobile phones) to address the sexual and reproductive health needs of women and girls in hard-to-reach places is in its infancy. However, ICT and health offer enormous business potential and many mobile phone companies are exploring possible business models. This creates potential for the government and commercial companies to cooperate and develop new initiatives. This report is an exploration of this complex and emerging landscape which looks at relevant policies and current practice, asking: how are poor women’s and girls’ needs in rural and peri-urban conditions catered for through technological innovation in health?
Maternal Mental Health in the Context of Community-based Home Visiting in a Re-engineered Primary Health Care System: A Case Study of the Philani Mentor Mothers ProgrammeIDS Evidence Report, 2014This document constitutes a briefing summary of the case study of a maternal mental health intervention in South Africa, the Philani Mentor Mothers Programme. The case study has been compiled by Professor Mark Tomlinson at Stellenbosch University as a contribution to the Empowerment of Women and Girls theme of the Accountable Grant at the Institute of Development Studies. In particular, it relates to the sub-theme that focuses on the health of women and girls in rapidly urbanising settings in South Africa and Kenya. The case study in this sub-theme discusses the particular health conditions that have been identified to affect women and girls in low-income urban settings, with a focus on identifying key ‘good practice’ and cutting edge interventions.
The Health of Women and Girls in Urban Areas with a Focus on Kenya and South Africa: A ReviewIDS Evidence Report, 2013This thematic review focuses on a range of health challenges faced in particular by women and girls living in low-income urban settlements in expanding cities in Kenya and South Africa. The review has been compiled as part of a larger body of work being conducted by the Institute of Development Studies (IDS) and its partners on gender and international development and financed by the UK Department for International Development (DFID). The review was preceded by a literature search (using keywords to reflect the thematic focus) of key databases of published literature, as well as a search for grey literature and documents describing interventions aimed at addressing these health challenges. An online discussion hosted by IDS gave a further indication of current debates and assisted in the identification of interventions.
A Case Study of Community-Level Intervention for Non-Communicable Diseases in Khayelitsha, Cape TownIDS Evidence Report, 2013Non-communicable diseases (NCDs) have become a major cause of mortality globally, but especially in low and middle-income countries (LMIC), where nearly 80 per cent of all NCD related deaths occur. There has been a growing interest in tackling the burden of NCDs in South Africa. In September 2011, the South African government convened a summit on the ‘Prevention and Control of Non-Communicable Diseases’ which produced a declaration that endorsed action aimed at various levels of risk factors, i.e. behavioural, environmental and structural, and further acknowledged the need for intersectoral collaboration. This case study looks at the town of Khayelitsha in South Africa, focusing in particular on the health of women and girls in a rapidly urbanising setting. It outlines the intervention as it was implemented in stages between 2001–2005. Further sections report on the interviews that were conducted, discuss the interview data and reflect upon the implications for the current policy plans for addresses the burden of NCDs in South Africa. It then concludes with a view to future interventions to address the NCD burden, specifically for women and girls, in contexts like Khayelitsha.