Innovative Responses to Urban Health Vulnerabilities in Sub-Saharan Africa

The high rates of urbanization amidst stagnating economies and poor governance have created a new face of abject poverty concentrated in overcrowded slum settlements in Africa’s major cities. Emerging evidence demonstrates that poor residents in African cities often experience worse health vulnerabilities than many other segments of national sub-populations, including rural residents. Analysis of the major causes of poor health outcomes among the urban poor suggests that effective programs need to simultaneously address: issues of access, availability, and affordability of health services; environmental sanitation; improvement of personal hygiene; and livelihoods. This paper reviewed some of the most innovative experiences in addressing these health issues among the urban poor residents and draws lessons to inform discourses on design and implementation of sustainable responses to urban health vulnerabilities. One of the key lessons from the review is that best practices derived from rural experiments cannot be transplanted to poor urban settlements since these populations have different epidemiological profiles; rely on multiple, weak, and often informal medical services; have weak community solidarity; and are subject to social and legal isolation due to the fact that they live in “informal or illegal” settlements. Successful programs in addressing urban health vulnerabilities should have a longterm perspective, establish strong partnership with the local communities and local government officials, and adopt a multi-sector approach aimed at improving various aspects of people’s lives. A major weakness in many interventions has been deficient capacity for documenting implementation processes and measuring the impact of interventions, which have undermined the potential for various programs to be objectively assessed for scale-up. More research obviously needs to be done to demonstrate cost-effective interventions to improve health outcomes among the urban poor. The urban poor also stand to benefit from nonplace-based initiatives aimed at improving access to health services by the general poor population, such as waiver of hospital fees. However, the success of these programs has been limited by lack of objective criteria and mechanisms for assessing eligible clients, and poor flow of information about the program to potential beneficiaries as well as health workers. The reviews covered in the paper demonstrate that carefully designed and implemented interventions can make substantive contributions in uplifting the well-being and reducing health vulnerabilities of the urban poor. Doing nothing about the escalating urban poverty and health crisis in sub-Saharan Africa is not an option anymore, since the welfare and health of slum residents will undoubtedly have far-reaching consequences on poverty alleviation programs and the achievement of the Millennium Development Goals. With increasing population mobility and globalization, the health problems and associated social ills that are rampant in poor urban communities (such as drug abuse, insecurity) are likely to filter to the regional and global stages.