Challenges of health programmes in slums.

Introduction The world is becoming increasingly urban. Of the projected increase of 1·1 billion in the world population between 2010 and 2025, virtually all will be urban dwellers. Urbanisation is mostly happening in lowincome regions, with Africa having the highest rate of all continents. The population growth rate in urban areas is almost double the rural rate but, more importantly, the slum growth rate is higher than the overall urban rate. In the next few decades, the proportion of the urban population living in slums in sub-Saharan Africa might therefore get even higher than the estimated 60% in 2010. Overall, the number of slum dwellers in low-income and middle-income countries is projected to double from one to two billion during the next 30 years. The UN Human Settlements Programme has identifi ed fi ve characteristics that defi ne a slum, namely inadequate access to safe water, inadequate access to sanitation and infrastructure, poor structural quality of housing, overcrowding, and insecure residential status. Governments, development partners, civil society, and other stakeholders recognise the need to develop social programmes that respond eff ectively to the needs of slum dwellers. However, little evidence exists for how to best design and implement such programmes in these deprived, often unpredictable, and dynamic settings, and for what challenges one might encounter in the process. The African Population and Health Research Center, in collaboration with international partners, has been working for the past decade in slum settings in Nairobi, Kenya, doing research and intervention projects. The aim of this Viewpoint is to share our experiences working in the centre and provide some insights into the complexities surrounding design and implementation of programmes aimed at improvement of health and wellbeing in such a dynamic setting.