Urban public health research in SSA: past, present and future 2001-2016

APHRC: What we Do

“A slum is not a chaotic collection of structures; it is a dynamic collection of individuals who have figured out how to survive in the most adverse of circumstances.”

The urban crisis and data needs Kenya typifies SSA’s urban crisis 5% annual growth in Nairobi’s slum population 60-70% of Nairobi residents live in informal settlements or in slum-like conditions Global and national indicators: Generally lack aggregation at local levels, National and citywide averages, blur sub-group inequities within urban areas. Cannot help answer a number of questions critical to the specific health and livelihood issues of the most vulnerable of urban dwellers, Yet such indicators will drive national indicators in the coming years following the volume of slum growth. Urban health programming is practically done at local levels by local governments, Yet there is a general lack of the urban health statistics needed by implementing agencies and local governments to baseline interventions and measure progress, assess cost effectiveness; identify interventions that work or otherwise

Pioneering Generation of Research Evidence on the Urban Poor 1. Nairobi Cross-sectional Slum Survey, 2000 Document population and health disadvantages of residents of Nairobi‘s informal settlements vis-à-vis the rest of Nairobi and Kenya Near absence of the public sector Limited access to education; Inadequate access to water and sanitation, Poor livelihood opportunities; Limited access to health care and RH/FP services Excess mortality and disease burdens It is against this background that APHRC designed and implemented in 2000, the Nairobi Cross-Sectional Slum Survey (NCSS I) Document population and health problems among the residents of Nairobi‘s informal settlements and Compare these with indicators from national surveys for other sub-groups of the Kenyan population. In 2002, APHRC also set up the NUHDSS which is a longitudinal platform to provide data and a research platform for investigating changing linkages between urbanization, poverty and health, and as a tool for monitoring and evaluation of the impact of the various interventions on health outcomes among the urban poor in Nairobi. In 2006-2010, the Center designed and implemented the Urbanization, Poverty and Health Dynamics project (UPHD) that aimed at investigating the interlinkages between migration, poverty and health status over the life course. 2011-2014: Gates Urban Health whose goal of the project is to consolidate APHRC’s leadership role in the generation of credible evidence to support programs and policies aimed at improving the wellbeing of the urban poor. Four components: Evidence generation (NCSS2, NUHDSS), Research capacity strengthening (ADDRF + travels awards, Partnerships (ISSP) and Policy engagement and communication (end user-friendly materials on urban health/RH, targeted meetings with various stakeholders).

Pioneering Generation of Research Evidence on the Urban Poor 2. Nairobi Urban Health and Demographic Surveillance System (NUHDSS) –2002-2016 About 70,000 individuals monitored every 4 months Understanding migration and other demographic processes Additional evidence on population and health disadvantages of residents of Nairobi‘s informal settlements vis-à-vis the rest of Nairobi and Kenya Platform for assessing interventions aimed at improving the lives of slum dwellers Critical resource for Nairobi CC, service delivery organizations, and development partners It is against this background that APHRC designed and implemented in 2000, the Nairobi Cross-Sectional Slum Survey (NCSS I) Document population and health problems among the residents of Nairobi‘s informal settlements and Compare these with indicators from national surveys for other sub-groups of the Kenyan population. In 2002, APHRC also set up the NUHDSS which is a longitudinal platform to provide data and a research platform for investigating changing linkages between urbanization, poverty and health, and as a tool for monitoring and evaluation of the impact of the various interventions on health outcomes among the urban poor in Nairobi. In 2006-2010, the Center designed and implemented the Urbanization, Poverty and Health Dynamics project (UPHD) that aimed at investigating the interlinkages between migration, poverty and health status over the life course. 2011-2014: Gates Urban Health whose goal of the project is to consolidate APHRC’s leadership role in the generation of credible evidence to support programs and policies aimed at improving the wellbeing of the urban poor. Four components: Evidence generation (NCSS2, NUHDSS), Research capacity strengthening (ADDRF + travels awards, Partnerships (ISSP) and Policy engagement and communication (end user-friendly materials on urban health/RH, targeted meetings with various stakeholders).

HIV/AIDS Declining & TB, Injuries, Cardiovascular Disease Increasing Over the ten-year period, the three major causes of death are HIV/AIDS (blue line), Tuberculosis (TB) (red line), and Injuries (green line) accounting for17.8%, 27.2% and 20.7% of all deaths, respectively. In 2003, HIV/AIDS (blue line) was the highest cause of death followed by TB (red line) and then Injuries (green line). However, by 2012 TB (red line) and Injuries (green line) had overtaken HIV/AIDS (blue line) as the major causes of death. Cardiovascular diseases (purple line):overall incidence significantly increases steadily over the years from 1.6% in 2003 to 8.6% in 2012, and peaking at 12.1% in 2009.

Pioneering Generation of Research Evidence on the Urban Poor 3. Urbanization, Poverty and Health Dynamics (UPHD) Project in 2006-2010 Understanding the interlinkages between migration urbanization, poverty and health outcomes Launch pad for various thematic areas of work Aging and development MNCH Adolescent SRH It is against this background that APHRC designed and implemented in 2000, the Nairobi Cross-Sectional Slum Survey (NCSS I) Document population and health problems among the residents of Nairobi‘s informal settlements and Compare these with indicators from national surveys for other sub-groups of the Kenyan population. In 2002, APHRC also set up the NUHDSS which is a longitudinal platform to provide data and a research platform for investigating changing linkages between urbanization, poverty and health, and as a tool for monitoring and evaluation of the impact of the various interventions on health outcomes among the urban poor in Nairobi. In 2006-2010, the Center designed and implemented the Urbanization, Poverty and Health Dynamics project (UPHD) that aimed at investigating the interlinkages between migration, poverty and health status over the life course. 2011-2014: Gates Urban Health whose goal of the project is to consolidate APHRC’s leadership role in the generation of credible evidence to support programs and policies aimed at improving the wellbeing of the urban poor. Four components: Evidence generation (NCSS2, NUHDSS), Research capacity strengthening (ADDRF + travels awards, Partnerships (ISSP) and Policy engagement and communication (end user-friendly materials on urban health/RH, targeted meetings with various stakeholders).

Consolidating Research on the Urban Poor 4. Nairobi Cross-sectional Slum Survey, 2012 Documenting changes and continuities of challenges faced by slum dwellers Investments and interventions in slums can result in tangible change More investments needed to address systemic challenges It is against this background that APHRC designed and implemented in 2000, the Nairobi Cross-Sectional Slum Survey (NCSS I) Document population and health problems among the residents of Nairobi‘s informal settlements and Compare these with indicators from national surveys for other sub-groups of the Kenyan population. In 2002, APHRC also set up the NUHDSS which is a longitudinal platform to provide data and a research platform for investigating changing linkages between urbanization, poverty and health, and as a tool for monitoring and evaluation of the impact of the various interventions on health outcomes among the urban poor in Nairobi. In 2006-2010, the Center designed and implemented the Urbanization, Poverty and Health Dynamics project (UPHD) that aimed at investigating the interlinkages between migration, poverty and health status over the life course. 2011-2014: Gates Urban Health whose goal of the project is to consolidate APHRC’s leadership role in the generation of credible evidence to support programs and policies aimed at improving the wellbeing of the urban poor. Four components: Evidence generation (NCSS2, NUHDSS), Research capacity strengthening (ADDRF + travels awards, Partnerships (ISSP) and Policy engagement and communication (end user-friendly materials on urban health/RH, targeted meetings with various stakeholders).

Key Findings on Nairobi’s Urban Poor-NCSS 2

Change and continuities in slum dwellers’ perceived challenges Findings show that water a key concern for about one in five of slum dwellers – a substantial increase from 2000. Smaller proportions of slum dweller report concerns about housing and access to education. The proportion of slum dweller who are concerned about unemployment has almost halved since 2000. Yet New Concerns not there in 2000 around garbage/sewer disposal and security has arisen significantly.

Changes in CPR driven by increase in married women not sexually active unmarried women

Increased HIV testing uptake Significant increases in the proportion of people who have been tested for HIV The greatest proportion of people get tested in public facilities Mobile clinics/research study involvement emerging as an important modality for people to be test

Increased delivery in health facilities Improvements in Nairobi indicators in the KDHS may be supported by the improvements in the slums in view of their proportion relative to the population of the city. This speaks to their role in driving national or city indicators.

Decrease in under-five mortality, but differences by division

Increase in proportion of children who are fully immunized at any time, but differences by division

Leakages across the continuum of NCD risk reduction

Potential for Interventions Community based nutritional counselling beneficial: Exclusive breastfeeding from 2% to 50% 1:71 increase in social value Partnership between the public and private sector can improve delivery of MNCH services and MNCH outcomes in underserved areas

Policy Achievements

What Next?

What is the Future of African Urbanization?

Key Focus Areas……. 2017-2021 Africa’s urbanization-course, causes and consequences Slums as a feature of African urban spaces, and determinants of overall urban well-being, including health outcomes Environmental impacts on health and wellbeing in urban contexts

Other Things That Interest Us….. Urban planning/Urban governance and consequences 2. Urban investments- policies, practice and consequences 3. Urban food systems: Production and supply chains, Formal and informal players, Controls and Regulations, etc. 4. Urban Risks/Disasters Natural and man-made Mitigation policies and practices

Moving Forward More outreach to funders in search of program funding Cement partnerships with international institutions