By Abu Conteh - Urban Health Research Assistant, SLURC
On 29th November 2017, Sierra Leone Urban Research Centre (SLURC) held a one day workshop to highlight some of the challenges, threats and drivers of health risks in urban Sierra Leone. The workshop brought together stakeholders drawn from central government ministries and agencies, the Freetown City Council, health NGOs, CBOs and community federations to discuss pertinent issues from the on-going scoping study report and to identifying what needs to be prioritized for SLURC’s Future Health Systems (FHS) research agenda on urban health.
The need for reliable health data
In his presentation, Dr. Joseph Macarthy pointed out that urban health risk factors in Sierra Leone are complicated by the unavailability of reliable data to guide policy decisions and programmatic interventions, needed especially in informal settlements where such problems abound. He noted that health data generated by the national agency (Statistics Sierra Leone) is often not disaggregated to reflect the circumstances in informal settlements. As a result evidence on urban health not only presents a blurred understanding of the kinds of issues to pursue, but also influences the desired outcomes in health interventions.
For these reasons, SLURC, is carrying out a scoping study that will:
- explore how the living conditions and other structural forces (framings and public narratives that influence policies) at the city level affect health outcomes for informal settlement dwellers
- identify existing knowledge gaps in urban health in Sierra Leone
- appraise the methodologies used in the studies and identify what else needs to be understood both to address the health risks and to improve the health conditions of informal settlement dwellers in urban Sierra Leone.
Dr. Macarthy noted that one key purpose that the scoping study will be to provide useful information to inform the design by government agencies and relevant NGOs of planned health interventions they wish to undertake, especially in informal settlements.
SLURC Health expert, Mr. Babawo outlined some of the key preliminary findings of the study for discussion:
- women and children are at the heart of all urban health problems
- unsurprisingly, most of the health risks are located in Freetown, compared to other urban areas in Sierra Leone
- Freetown’s high health risks cannot be unconnected to the high rate of urbanization, the rise in population and the associated sprawling leading to the proliferation of unplanned settlement development both in the center and on the fringes of the city
- other factors relate to the rise in air pollution, increased community exposures to flood and health disaster risks, and the limited access to health services, especially for vulnerable and low-income earners living in informal settlements.
Identifying the knowledge gaps
While noting the important role that data can play in informing the design of sound policies and programmes, it was recognized that unless active actions are taken to fill the existing knowledge gaps in the identified areas, it will be difficult to improve the wellbeing of much of the poor, vulnerable and marginalized groups living in informal settlements.
The participants at the workshop took part in group work to identify some of the key issues that had received insufficient attention in the past, with a view to prioritizing them in SLURCs upcoming study. These included:
- malaria prevention, nutritional support, and increased health access for women and children
- community health education/awareness
- capacity of health workers for improved health service delivery
- the health effects of improper waste management and poor sanitation
- procurement and the supply of drugs to health facilities
- health policies and adequacy to address current and emerging health needs
- flooding and the health effects of poor drainage systems on informal settlements
- the role of sanitation and good hygiene practices to avoid the spread of diseases.
The participants also described how whilst there were a high number of health organizations working in informal settlements in Freetown, overall the outputs seem low and have minimal impact on the communities. This was put down to the uncoordinated response by organisations and a duplication of efforts because interventions are rarely guided by evidence-based knowledge.
What should SLURC prioritise?
For that reason, the participants emphasised the need for SLURC to intensify its effort in providing these organisations with current, accurate and reliable data and health knowledge to guide their interventions. With regards to urban health, the added research issues identified for SLURC to prioritise in the short and medium term included:
- what makes specific categories of people in informal settlements more vulnerable to epidemic diseases (e.g. cholera and diarrhea) than others?
- why the high preference for Traditional Birth Attendants (TBAs) over trained health professionals in informal settlements?
- why the high prevalence of maternal and child mortality in informal communities?
- the impact of Sexual and Reproductive Health services on teenage pregnancy levels in Freetown
- the impact of poor housing conditions on health outcomes in informal settlements.
The workshop proved to be an extremely useful and engaging event which enabled SLURC to not only present its research findings but to also gather crucial input from a group of informed stakeholders about what other health issues need to be explored in its work. These discussions will now be combined with the earlier findings to provide a clear understanding of the baseline situation on urban health knowledge, it will also help to define the future research priority areas for SLURC.