Leveraging International Policy to Reduce the Threat of Vector-borne Diseases in the Built Environment BOVA Network Meeting 28th March 2019, London Dr Graham Alabaster Chief of Waste Mangement and Sanitation UNHabitat graham.alabaster@un.org

Key Questions What international policies can be used to leverage action for creating healthier settlements that would reduce the threat from Aedes-borne diseases ? At the international level who are the chief actors to engage? What role do the development banks have to play in this? How can health, and more specifically vector-borne diseases, break into the built environment sector?

Urbanization trends Most megacities are In the global south (China, India, Brazil) One in five urban dwellers live in medium sized cities or 1-5 million In 2014 close to half urban residents lived in settlements smaller than 500,000 The fastest growing agglomerations are medium sized cities and cities with less than 1 million in Africa and Asia Some larger cities have experienced a population decline since 2000

Urbanization trends

Large urban centres include megacities, urban areas with a clear central business district (CBD) and suburbs with varying levels of progressively decreasing population density (Lagos, Nigeria) Large urban centres resulting from conurbations, where two or more distinct urban centres progressively grow and see their population density increase, until they more or less merge into one metropolitan area. (Accra-Tema , Metro Manila) Smaller urban centres typically are towns that have a small CBD, possibly some small satellites and radial linear expansion along the major routes. (Lake Victoria region East Africa) Large villages and small towns are typically quite compact but differ from urban centres as they have little fringe expansion including areas around industrial or commercial activities. college campuses, airports, mining communities, refugee camps. Rural areas low density disbursed settlements Urban Typologies

The Urban Environment & Aedes-borne disease Aedes aegypti and Aedes albopictus mosquitoes are the primary vectors for dengue, chikungunya, yellow fever, and Zika viruses. Taken together, these viruses account for almost 100 million cases of mosquito-borne disease per year. Poor solid waste management has allowed Ae. aegypti to flourish in small bodies of water found in discarded plastic containers, plant pots, gutters and tires. A lack of piped water or insecure water supply means that communities often store water in their homes in containers which provide habitats for Aedes mosquitoes. Poor roads and drainage provide additional habitats The Urban Environment & Aedes-borne disease

The Sustainable Development Goals: A good opportunity World Health Organization 15 November, 2018 The Sustainable Development Goals: A good opportunity The SDGs present a real opportunity to link Urbanization and Health outcomes The SDGs will be measure in all countries so a means has to be found to encourage all members states to participate at a level commensurate with their resources Everyone is worried about the cost of monitoring and how it will impact on budgets The indicators with the most usefulness with be those with clear outcomes that drive policy An effective cross mapping of the indicators between health and urban (and some other goals) is needed

Sustainable Development Goals AN integrated agenda for development SDG 3 Health SDG 12 Production and Consumption SDG 6 Water, SDG 11 Cities ? Sustainable Development Goal (SDG) 11: ‘making cities and communities… safe, resilient and sustainable’ which calls for governments and partners to “ensure access for all to adequate, safe and affordable housing and basic services and upgrade slums”. Creating tropical and sub-tropical communities that are undesirable to Ae. aegypti should be a priority for safe, resilient and sustainable modern cities. ….

SDG 11 in practice NEEDS GOOD URBAN DESIGN (Planning) HOUSING & BASIC SERVICES (dwelling & living environment) MONITORING (leave no one behind) Different approaches for different Urban Typologies

Experience from the Monitoring of the SDG for Water (Goal 6) World Health Organization 15 November, 2018 Experience from the Monitoring of the SDG for Water (Goal 6) Develop both national and global monitoring approaches which support one another Definitions need to be standardized. The indicators must be simple, easy to communicate and understand. Complex “index” type indicators were difficult to understand and measure and may not be relevant in particular country contexts Encourge more collaboration between the thematic and statistical community to ensure measuraility is practical and achievable Proof of concept is needed The monitoring ladder concept was widely supported Data do exist but remain un-reported. They can be disaggregated to improve attractiveness as a management tool

The New Urban Agenda The New Urban Agenda is the outcome document agreed upon at the Habitat III cities conference in Quito, Ecuador, in October 2016. It will guide the efforts around urbanization of a wide range of actors — nation states, city and regional leaders, international development funders, United Nations programmes and civil society — for the next 20 years

Advocating a three pronged approach to urban development Urban Rules and Regulation Adequate planning rules and regulations are a prerequisite to the design, production and management of efficient and equitable & healthy human settlements Urban Planning and Design The quality of urban planning and design has a determining impact on the value generated by human settlements through efficient and equitable public space, streets and buildable areas Municipal Finance Efficient and transparent municipal finance systems are key to investments maintenance and management of the city. They should ensure redistribution of benefits generated by urban endogenous development

WHO Vector Control Response Priority activities set out in the GVCR fall within 4 pillars that are underpinned by 2 foundational elements: Pillars of action • Strengthen inter- and intra-sectoral action and collaboration • Engage and mobilize communities • Enhance vector surveillance, and monitoring and evaluation of interventions • Scale up and integrate tools and approaches Foundation • Enhance vector control capacity and capability • Increase basic and applied research, and innovation Successful implementation of the GVCR will require strong country leadership, advocacy, resource mobilization and partner coordination, along with regulatory, policy and normative support.

What are the tools we can use ?

Finance: Working with the Development Banks experience of UNHabitat Water & Sanitation Trust Fund Combining fast-track support technical assistance for UNHabitat with longer-term financing from the development banks (blended finance)   Fast-tracking participatory processing in project design Joint coordination of identification missions Critical pre-investment capacity-building can improve the resilience of service providers and utilities to make them more capable of servicing loans. Urban areas of different sized need different financing packages, with an increasing component of grant financing required with decreasing size of urban centre Many tools developed by UNHABITAT on Land, infrastructure and disaster response are already available which can be directly used or readily adapted to fast track capacity-building components of projects. Collaboration in many cases between the development banks and UNHABITAT has resulted in greatly reduced project preparation periods.

Urban design & Legislative approaches Urban plans and infrastructure which promote vector eradication Focus attention on slum upgrading and low-income communities Improved disaggregated monitoring to highlight intra-urgan differentials Support to local authorities for intergrated approaches at local level and local bylaws Mobilise community efforts (multi-stakeholder forums)to assist in design and preventative approaches

Lake Victoria Water & Sanitation Initiative

The Role of Multi-stakeholder forums in project implementation

Applying the approach to vector –borne disease eradication in The Lake Victoria region

Objectives 1) Promoting integration of malaria reduction targets into national plans/strategies in key non-health sectors which are relevant to the malaria endemicity, including political support for improved regional cooperation 2) Supporting implementation of national guidelines integrating malaria reduction targets and malaria-intelligent practices by local authorities/communities in the Lake Victoria region, through development, pilot testing and application of innovative tools. 3) Building up a regional capacity for technical exchange and for surveillance/monitoring and evaluation of impact across the sectors involved.

The consultative process Conduct cross-country planning session/s with national authorities Agriculture, Housing, Water and Sanitation on how to integrate malaria risk reduction in national plans/strategies, utilizing newly developed tools.  Develop and organise multi-stakeholder forums with communities and local opinion leaders to obtain a greater understanding of the impacts and effectiveness of current approaches Build political support for regional approaches through high-level advocacy meetings and development of regional action plans.

Tool Development and Application Develop decision support tools for malaria management based on social and environmental determinants and novel systems of data capture and analysis: Organize workshop/s for officials from district/municipalities and community leaders to develop cross-country cooperation in implementation of national guidelines and in the testing and application of new tools and approaches. Pilot testing in 2-3 selected locations in each of the five participating countries. Pilot-scale evaluation and scale-up plans, building of the experience from the field trials, plans will be made for the region-wide scale up of refined tools. Development of multi-sectoral implementation plans following the successful field implementation.

Institutionalising the approach Establish regional technical exchange capacity Establish regional monitoring and evaluation platform. Expand epidemiological and entomological monitoring database, building the M&E platform as a GIS will enable better targeting of interventions and overlay with thematic information from other sectors, such as environment, housing and agriculture. Develop refined advocacy and awareness programmes/campaigns

Conclusions Seize the opportunity of the SDGs & NUA to make multi-sectoral approaches to Vector Control the norm Unlease the power of communities & local authorities in design implementation and monitoring and local bylaw formation Use blended finance mechanisms with different approaches for urban areas of different sizes Ensure oversight through regionally-established political actors