1. 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

2. 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?

3. 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

4. Urbanization trends

5. 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

6. 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

7. 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

8. 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. ….

9. 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

10. 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

11. 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 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

12. 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

13. 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.

14. What are the tools we can use ?

15. 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.

16. 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

17. Lake Victoria Water & Sanitation Initiative

19. The Role of Multi-stakeholder forums in project implementation

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

21. 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.

22. 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.

23. 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.

24. 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

25. 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