Blog - Urban SHADE

शिमला की बस्तियों में सर्वेक्षण करने का अनुभव

शिमला की बस्तियों में सर्वेक्षण करने का अनुभव साहिल कुमार 2021 में, मैंने अपनी ग्यारहवीं और बारहवीं लाल पानी स्कूल, कृष्णा नगर से की थी। मुझे मेरे घरवालों ने बताया था कि किसी के साथ काम से हटके बात नहीं करनी है, और किसी से लड़ाई झगड़ा नहीं करना है। घर के बड़े मानते हैं कि वहां लोग जल्दी लड़ाई झगड़े में उतर आते हैं, पर मेरे साथ स्कूल के दौरान कभी ऐसी कोई घटना नहीं हुई। सितंबर महीने में जब मैंने Urban SHADE प्रोजेक्ट में काम करना शुरू किया, तभी यही धारणा मेरे मन में थी। मेरी टीम का काम था कि घर-घर जाकर सर्वेक्षण करना। हम पूरे सात लोग ये काम पर लगे थे। इस प्रोजेक्ट में काम शुरू करने के बाद, कृष्णा नगर के लोगों और जगह के बारे में मेरी धारणा और अनुभव में आया बदलाव। हमने Urban SHADE प्रोजेक्ट हिमाचल प्रदेश के शिमला की अनौपचारिक बस्तियों में घरेलू स्तर पर सर्वेक्षण से संबंधित आँकड़े एकत्र करना शुरू किया। हम दो बस्तियों – कृष्णा नगर और ईदगाह कॉलोनी – में काम कर रहे थे। घरेलू सर्वेक्षण का उद्‌देश्य अनौपचारिक बस्तियों में रहने वाले लोगों के स्वास्थय पर पड़ने वाले प्रभावोंऔर कमज़ोरियों को समझना है। साथ ही चरम मौसम की घटनाओं के दौरान और उसके बाद सार्वजनिक स्वास्थय सुविधाओंमें उपलब्धता को भी समझना है। यह मेरा पहला काम था। मेरा, शुरुआती अनुभव बिल्कुल ना के बराबर था लेकिन पहले ही दिन से नई चीजों को सिखने पर ध्यान दिया। जब पहले दिन हम अपने क्षेत्रों में पूरी टीम के साथ गए तो हमने देखा कि कृष्णा नगर में रास्ते सीधे नही है और बहुत सी सीढ़ियाँ है। यहाँ पर लोगों के घर बहुत पास-पास है, और भारी बारिश के दौरान लोगों के घरो के जल निकासी की स्थिती बहुत खराब है। कृष्णा नगर के लोगों का कहना यही था कि बहुत से लोग आते-जाते है और सर्वे कर के चले जाते है। परंतु कोई हमारे लिए कुछ भी नहीं करता। मैपिंग की समस्याएं हमें ट्रेनिंग के दौरान मैपिंग के बारे में बताया गया। सर्वे के पहले मैपिंग जरूरी थी ताकि कृष्णा नगर की भौगोलिक स्थिति के बारे में और घरों की स्थिति के बारे में अच्छे से पता चले। दोनों क्षेत्र- कृष्णानगर और ईदगाह पहाड़ी क्षेत्र हैं,और रास्तों में उतार चढ़ाव बहुत है। मेरे सीनियर्स और टीम मेंबर्स को भी कृष्णा नगर में मैपिंग के दौरान ऊपर नीचे चढ़के थकान का सामना करना पड़ा। हम सोच में पड़ गए कि यहाँ के लोग, विशेष रूप से बुज़ुर्ग लोग, कैसे रोज चलते फिरते होंगे। सर्वे के दौरान हमें बुज़ुर्ग बताते थे कि उन्हें नीचे से कार्ट रोड पहुँचने में बहुत समय लगता है। बहुत से बुज़ुर्ग डंडा पकड़कर, बीच में बैठ-बैठ कर धीरे-धीरे ऊपर तक पहुँचते हैं। मैपिंग में मुझे कई जरूरी चीजों का ध्यान रखना पड़ता था। कोई घर छूट ना जाए। लोगो से रास्ते को पूछना या कौनसा घर किस से जुड़ा है। कृष्णानगर में पालतू और आवारा कुत्तों का डर बहुत ज्यादा था। हमें डर था कि ये आवारा कुत्ते हमें ही काट न दें। हम लोगों को पूछ कर ही गालियों में जाते थे। जिन घरों में पालतू कुत्ते होते थे वह उन्हें पकड़कर या बांधकर रखते थे। हमने सुरक्षित होकर मैपिंग का काम चालू रखा । मैपिंग में हमें एक ही गली में कई बार आना जाना पड़ता था। शुरुआत में थोड़ी थकान के साथ समय वाला काम लगता था। फिर मुझे इसकी आदत होने लगी। मैंने मैप के चित्र का ज्यादातर काम खुद ही किया है। मैप को पहले मोटे तौर पर बनाया और फिर उसे बड़े चार्ट में लैंडमार्क लिखकर तैयार किया।यह काम मुश्किल था क्योंकि गलीयाँ कहीं न कहीं एक दूसरे से मिलती हैं। इस दौरान, मैं और मेरी टीम घंटों वाल्मीकि मंदिर में बैठकर काम करते थे। वहाँ का माहौल अच्छा था और लोगों को हमारे काम के बारे में जानने में दिलचस्पी थी। मुख्य घरेलू सर्वे की शुरुआत पायलटिंग के दौरान मेरी एक परिवार से बात हुई। इन लोगों ने 2023 में स्लॉटर हाऊस के हादसे को अपनी आंखों से देखा। उन्होने अपने घर के साथ लगती नालियों और बुरी जल निकासी (drainage) के बारे में बताया। उन्होंने बारिश के दौरान अपने घर को छोड़ने की स्थिती और अनुभव को मेरे साथ साझा किया। एक और दुखी परिवार के अनुभव को भी मैने सुना था। उन्होनें कुछ साल पहले नया घर खरीदा था जो कि 2023 के स्लॉटर हाउस क लैंडस्लाइड (landslide) हादसे में तबाह हो गया।आज उस परिवार को किराए के घर में अपना जीवन यापन करना पड़ रहा है। सर्वे के पहले दिनों में मेरा अनुभव ठीक रहा और लोगो से बात करके अच्छा लग रहा था। सर्वे के तीसरे दिन, जब मैं एक आदमी से सर्वे के सवाल पूछ रहा था, उन्होंने घर के संबंधित सवालों के बारे में बुरा मान लिया। उनका व्यवहार मेरे प्रति बहुत अच्छा था परंतु उनको सर्व के कुछ प्रश्नों से थोड़ी परेशानी थी। उन्होंने सर्वे रोकने को कहा और उन्होंने मुझे डेटा टैबलेट से मिटाने को भी कहा। कुछ देर के लिए उन्होंने टैबलेट मेरे हाथ से लेकर उसमें कुछ देखने भी लगे। इसके बाद में हमारे टीम के सीनियर ने कृष्णा नगर के वाल्मीकी मंदिर वहाँ के निवासियों के साथ बैठक की । उन्होंने सर्वे के बारे में अच्छे से समझाया। इस बैठक से लोगों को समाधान मिला और सर्वे सामान्य तरीके से चल पड़ा। और उसके बाद वाल्मिकी सभा के लोगों ने हमें सर्वे के लिए और ज्याया प्रोत्साहित किया। लोगों को दिक्कत व परेशानियाँ लोगो का मेरे प्रति व्यवहार अच्च्छा रहा। लोग जानकारी देने के लिए पूरा समय देते थे और अपने पूर्व प्रभावो को हमारे साथ साझा करते थे। लोग अपनी गंभीर बीमारियों के बारे में भी हमारे साथ जानकारी साझा करते थे। लोगों ने बताया कि कार्ट रोड तक आने-जाने से जोड़ों में दर्द होता है।यहाँ का नाला कूड़े से भरा रहता है, और जो लोग नाले के पास रहते हैं वे इससे ज्यादा परेशान रहते हैं। इससे वर्षा के मौसम में समस्या आती है और बीमारियाँ पैदा होती हैं। कृष्णानगर में ऐबुलेंस की सेवा भी ना के बराबर है। मौसम के कारण

Blog

How terrain of the informal settlements has impact on health

How terrain of the informal settlement has an impact on health Almenatu Samura It is well known that living in informal settlements poses a risk to health because of lack of formal recognition, and the residents facing various socioeconomic, environmental and political exclusions. In the coastal informal settlement of Susan’s Bay, one’s access to health is also determined by what part of the settlement she lives in. Since the settlement is built on steep, tiered landscape, people living in the lower parts of the settlement have to climb long flights of uneven stairs to get anywhere. This includes going to the only public health facility, Susan’s Bay Community Health Centre that serves the settlement, which is perched on the upper end of the informal settlement. While this reality touches every resident, it falls heaviest on the most vulnerable groups persons with disabilities, the elderly, children, and especially pregnant women. The terrain makes daily movement for residents, especially vulnerable ones, exhausting and sometimes impossible. “There’s no part of the community without staircases. To exit the area, you must climb, which is a major challenge for us,” one resident explained. Residents at the lower end of the settlement struggle to reach it, especially during medical emergencies, and disasters such as fire and storms. In 2021, a massive fire swept in Susan’s Bay injuring hundreds of people and destroying much of the infrastructure. The lack of roads prevented fire engines to reach the community to put out the fire. Life-threatening delays during childbirth Pregnant women find the uphill journey daunting, often missing critical antenatal appointments or experience life-threatening delays to reach the health facility during labour. The consequences are devastating from miscarriages and preventable complications to tragic maternal and newborn deaths. The community members talk about cases where pregnant women have failed to reach health centre, losing their lives. As per the latest UN estimates, Sierra Leone has made strides in reducing the maternal mortality ratio from 1682 deaths per 100,000 live births in 2000 to 354 in 2023. But 354 deaths per 100,000 live births is still too high a number- about three maternal deaths a day. Stories of women dying of childbirth abound in the settlement. A community leader speaks about the case of a pregnant woman who died of childbirth after she could not reach the health centre. She lived in the lower end of the informal settlement. “The pregnant woman was unable to reach the health center. She returned home and delivered with a traditional birth attendant (TBA). The mother couldn’t make it out alive,” recalled a community leader. After the complications, the woman was taken to the health facility where an emergency C- section was done. Beyond the steep terrain, narrow and congested roads compound the crisis. Traders often line the pathways, leaving little space for movement. The environment is physically inaccessible, disaster-prone, and socially excluding. This is especially true when a fire breaks out, or during floods when it is impossible to move fast. A disabled resident said that being carried on someone’s back is “dehumanising.” No “free” healthcare There are other barriers to access to healthcare. Despite the Free Health Care Initiative (FHCI) that was launched in 2010, people talk about hidden costs, medicine shortages. Informal payments keep many away from clinics. Many residents living in Susan’s Bay lack reliable income and the rising cost of living is deepening their hardship. This hardship is compounded for vulnerable populations who then depend on informal health care rather than the formal system. “I don’t have a steady job, so if I can’t afford tests or drugs, I simply go without treatment,” said a man with a disability. A recent Human Rights Watch report looking at obstetric violence in Sierra Leone said that indigent women are at a higher risk of obstetric violence if they cannot make informal cash payments to staff in government facilities for services, drugs, and other commodities, even if in an obstetric emergency. The report is based on more than 130 interviews with patients, healthcare providers, government officials, and public health and policy experts in Sierra Leone in 2024 and 2025. Community health workers say that many pregnant women too are abandoned by their partners, left to fend for themselves. Accessing formal healthcare becomes daunting for such women. In the face of these barriers, community health workers (CHWs) serve as the invisible bridge between the health system and those most at risk. They identify pregnant women who have not registered for antenatal care, provide referrals, and raise awareness on safe delivery practices. “Some women never attend ante-natal until CHWs visit them at home. Many don’t even have antenatal cards,” said a CHW. Without their outreach, maternal and newborn deaths in Susan’s Bay would likely be far higher. Susan’s Bay’s story is not an isolated one. Across Sierra Leone’s informal settlements, residents find it difficult to access healthcare. Addressing this requires more than infrastructure; it demands inclusion, empathy, and sustained attention. To build resilience in Susan’s Bay, interventions must prioritise accessible and inclusive healthcare facilities, improved mobility pathways for persons with disabilities and the elderly, community-based maternal health programs, livelihood support for vulnerable women and people with disabilities, and stronger emergency preparedness and response systems.

Blog, India

Experiences of co-creating survey with communities facing climate health risks

Experiences of co-creating survey with communities facing climate health risks In late October 2025, the Urban SHADE project in India will start on data collection related to the household level survey in the informal settlements in Shimla in Himachal Pradesh, Vijayawada and Guntur in Andhra Pradesh. The household survey aims to understand health impacts and vulnerabilities of people living in informal settlements, as well as the extent of care available to them in public health facilities during and following extreme weather events. The Urban Shade Project, aims to strengthen health services for people living in urban informal settlements, to respond to impacts of extreme weather events. The enumerators in both states underwent an extensive training programme in September, which covered the details about the project, ethics of data collection, mapping and use of survey software. The project has involved the community in every step of the way. The design of the survey tool – Household Survey: Social and Health Vulnerability Assessment related to Extreme Weather Events– was led by a member of the research team, Malini Aisola with extensive inputs from research and field team members. The survey includes social demographic profiles of household members, access to utilities and infrastructure, access to health services, housing, past impact of extreme weather events, people’s perceptions, awareness and responses on extreme weather events. The survey will be conducted in informal settlements in Vijaywada-Guntur, and two informal settlements in Shimla. The two extreme weather events we are looking at in the project are extreme heat and extreme rainfall/flooding.Through the household survey, the team aims to generate context-specific data about a variety of indicators of social and health vulnerability, and provide insights about how they shape experiences of extreme weather events. For example, those living in the poor quality houses, and do informal work may feel the impact of extreme heat more.The survey would enable granular descriptions at the settlement-level of prevailing conditions that could inform government policies and local preparedness planning including provision of health services. Consulting the community on survey tool The Urban SHADE research teams had fortunately worked with some of the settlement sites in the project earlier in another project called Accountability for Informal Urban Equity (ARISE), an action research project focussing on health and wellbeing of sanitation workers. In some other communities, efforts were made to engage with the community in a meaningful way before data collection. In Eidgah colony, a public meeting was organised with support from key stakeholders including the Maulvi of the mosque, the ward councillor, community leaders, an official from National Health Mission and ASHA workers in the settlement. Anmol Somanchi, a developmental economist and member of the research team in an advisory capacity, helped the team develop a conceptual framework for measuring vulnerabilities. After developing a basic draft with inputs from research and field team members, our team presented it to the members and stakeholders of the settlements in Vijayawada, Guntur and Shimla. The workshops included residents, community leaders, elected officials, health workers, civil society members of these settlements we are studying in including Krishna Nagar, and Eidgah colony in Shimla, Vambay colony and New Raja Rajeswari Peta (also called RR Peta) in Vijaywada, and Sarada colony in Guntur. The one-day workshop was organised by the research team of Inayat Singh Kakar and Yetika Dolker in Shimla, and Pavani Pendyala and Hemanth Chandu in Vijayawada in May. Apart from talking about the survey, key questions were read out and displayed in the workshop to the community members to discuss their relevance, the way they are worded, as well how the data could be relevant to the community for advocacy. Community members gave suggestions on improving the questions as options to click to elicit an appropriate answer. Mahesh aka Shiva who lives in RR Peta gave suggestions to simplify the Telugu questions, making it closer to spoken language rather than very Sanskritised. “In the workshop, you (Urban SHADE team) asked us whether we were able to understand the language or not, and modified the questionnaire based on the language we were able to understand,” said Mahesh. The workshop helped the research team to overcome engagement challenges in one of the settlements in Andhra Pradesh who were unfamiliar with the research teams’ work and helped familiarise them with the research. These members helped facilitate community engagement for the researchers. Reena Chauhan, Accredited Social Health Activist or ASHA worker works with the community in Eidgah colony. ASHA workers work closely with the communities and link them up with services in the public health facilities. Asha workers used to conduct government-related surveys. “For the first time, someone has asked us anything before conducting any kind of survey. Usually we are just asked about our targets related to our work in taking pregnant women for check ups or checking on newborns, or motivating tuberculosis patients to take their medicines,” said Reena Chauhan, ASHA worker in Shimla Taking feedback from the community is in line with participatory action research methodology which this project is committed to. It also adheres to the principle laid down in the Human Rights Approach to Data, that talks about including means for active, and meaningful participation of relevant stakeholders, especially the most marginalised population groups during the entire data collection process including planning before the survey roll outs. Deciding boundaries of the settlement For the project and particularly for the survey, it was important to determine the boundaries of the settlement- what part of the settlement will be covered for the survey, and what will be left out. The boundaries then determine where the enumerators and researchers 1can move around and conduct the survey. In Vijayawada and Guntur, there were some areas adjoining the informal settlements where the middle class families lived in visibly well-made houses. The project’s Vijayawada-based researcher, Hemanth Chandu sat with community persons, Madhavi, Kosamma, Mahesh and Shiva in RR Peta and Vambay Colony, Vijayawada and Akkamma and Shiva Parvati in Sarada Colony, Guntur. Of these, Madhavi and Shiva Parvati are community

Blog, Sierra Leone

When Communities Map Themselves, Policymakers Start to Listen

When Communities Map Themselves, Policymakers Start to Listen Geographic Information System (GIS) is a computer system for capturing, storing, analysing and displaying data that are spatially referenced to the earth. GIS is used to create maps, analyse patterns and identity relationships. GIS is increasingly used as a tool to help map informal settlements with respect to utilities, waste management, roads, infrastructure, among others. Richard Bockerie is a seasoned data and software development professional with over a decade of experience in advanced data collection, management, analysis, and mapping, specializing in community-driven research and climate resilience projects. Holding a degree in Computer Science, he has effectively led mapping and training initiatives across multiple African countries. As Programme and Technical Manager at the Centre of Dialogue on Human Settlement and Poverty Alleviation (CODOHSAPA), the Sierra Leone affiliate of Slum Dwellers International (SDI), Richard leverages cutting-edge data platforms and GIS technology to provide actionable insights that underpin climate adaptation strategies and sustainable development policies. His work centers on delivering reliable, high-quality data critical for research on climate change impacts, urban planning, and community resilience. With expertise in monitoring and evaluation, system development, and business analytics, Richard empowers stakeholders to make evidence-based decisions that enhance environmental sustainability and socio-economic well-being in vulnerable populations. Through his role, Richard contributes to global efforts addressing climate change challenges by bridging technological innovation with grassroots knowledge, strengthening capacities for informed climate action in the most affected regions. Richard spoke to Menaka Rao, Urban SHADE’s Project Communication Officer. These are the excerpts of the interview. Menaka: How did you first start using GIS mapping in informal settlements? Richard: We began using GIS in 2015. At that time, I was responsible for analysing data of a household survey. While quantitative data provided valuable insights, I realised it did not capture the full reality on the ground. We needed a way to represent the data spatially for a clearer picture. “Unlike traditional reports filled with graphs and tables, a map resonates with people because they can see and identify their own neighborhoods, homes, and places of work. This connection empowers them to participate actively in planning and decision-making.“ For example, if I say 50% of households lack access to water points, that’s useful. But it’s even more actionable when I can pinpoint which specific zones those households are in. Mapping the data allows us to identify areas with high and low access to services. Another instance is when community members report exposure to flooding, landslides, and other hazards—GIS lets us locate exactly where these risks exist. It became clear that quantitative and qualitative data alone couldn’t tell the entire story. GIS tools became essential in supporting our evidence and enabling evidence-based decision-making. Maps make the data more relatable and understandable for communities. Unlike traditional reports filled with graphs and tables, a map resonates with people because they can see and identify their own neighborhoods, homes, and places of work. This connection empowers them to participate actively in planning and decision-making. Menaka: What can GIS mapping do to help us understand informal settlements? Richard: GIS has huge potential to help us understand informal settlements because these places exist in physical space. When we talk about land rights, access to services, or building infrastructure, we need to show exactly what is in that space—who owns what land, the size of the community, the number of buildings, and common risks like flooding or landslides. For example, if we want to help communities get land ownership, we need to clearly map the area so people can have official documents and title deeds for their land. That’s where GIS helps. GIS mapping also lets us see who has access to services and who doesn’t. I worked on a project in Freetown with the University of Chicago where we mapped the whole city’s access to essential services using the K block analysis. We found that areas closer to roads had better service than those without road access. This data helped city officials realise the problem. Because of this, the city started a project to build roads in Kroobay, a settlement in Freetown, which has made it easier to bring services to people there. So, GIS gives us clear evidence of challenges and opportunities, and when we show this to city leaders and government, they are more likely to take action. Menaka: You conduct GIS exercises with community researchers. Can you help us understand with examples how GIS helps community members understand their own locality better? What insights do they get when they do this exercise? Richard: In participatory GIS, community members create maps of their settlement themselves, instead of outsiders doing the mapping for them. This process helps them understand their community deeply. For example, we take drone images, print them, and bring them to the community. We first explain the images and then ask them to mark important places on the map. They mark where they live, work, and parts of the settlement prone to hazards like flooding. In one exercise, we asked them to show where they dispose of waste and then identify flooding areas. They clearly saw the link between waste disposal and flooding. This helps them realize how daily actions affect everyone in the community. Menaka: Can you also give me an example about how the understanding about a particular settlement has changed after the use of GIS and how it can help identify issues that can be worked on by policy makers and other stakeholders. Richard: And I’ll give you an example of one of Moyiba in Freetown, where the Urban SHADE project is working. When we started doing the GIS mapping, we understood that whenever it rains, the access to the committee is completely cut off because of the road network. You can’t access health facilities or any emergency services. Moyiba is a hillside settlement. We were able to draw the conclusion that the rain comes from top and slopes downwards. We could tell the community that we need to pave

Blog, India

When an informal settlement has no PHC

When an informal settlement has no PHC Yetika Dolker As a public health professional, I have worked in the remote and rural areas of Lahaul-Spiti and Kinnaur in Himachal Pradesh to Udaipur in Rajasthan and in the plains of Bihar. I now with the Urban SHADE project with urban marginalised settlements in Shimla. Urban and rural health care systems are worlds apart. In rural and remote areas, reaching the facility is difficult because of extreme climate or rugged terrain. Often there is a lack of trained health personnel, or diagnostics or treatment provision in these areas. In urban areas, the public health challenges are different as I have discovered while working with informal settlements in Shimla, the capital of Himachal Pradesh. While urban areas have better access to advanced healthcare facilities, trained healthcare personnel and technology, the most basic level of health care is often lacking. Especially for people who need it most- the urban poor who live in informal settlements. People here are also more vulnerable to diseases as they lack access to safe drinking water, sanitation, good nutrition. Climate change and its effects also affect these vulnerable persons more. Hidden health risks In Shimla extreme rains, landslides, flooding, treefalls and rock falls are common during the monsoon. The Urban SHADE project works in Krishna Nagar settlement and Idgah colony in Ruldu Bhatta. Both are informal settlements, perched atop the edges of hills making them even vulnerable to landslides and floods. A major landslide in Krishna Nagar in 2023, felled an entire slaughterhouse in the colony, and killed at least two persons. The houses here are often overcrowded, with poor ventilation, sometimes stinking due to garbage. There is barely any sanitation here. “Dog’s potty is everywhere. Walking around it is like playing stapu (hopscotch). In the rains, the muck gets inside the shoes. What to say. We live in such filth,” said a woman who lived in Krishna Nagar in a focus group discussion (FGD). “It appears that all the filth from the city comes and collects here. The gutters are open and flowing. Walking in the pathways makes you feel dirty,” woman from Krishna Nagar said. Public washrooms remain dirty, and women in these colonies say they suffer from pelvic infections as a result. The water supply is often contaminated, and people say they get gastrointestinal diseases as a result. “When there is a water cut, often the water supply is contaminated. We have heard of jaundice cases in many houses in those periods,” said a woman from Idgah colony. Residents here complain of deliberate neglect by municipal authorities. “Why do you think other areas in the city are not so dirty, madam,” asked a woman from Krishna Nagar. “The other areas in the city are so clean, and neat. It appears that all the filth from the city comes and collects here. The gutters are open and flowing . Walking in the pathways makes you feel dirty.” No PHC in the settlements To top all these existing health problems, there is no subcentre or primary health care centre (PHC) within both these settlements. A PHC or dispensary is the first point of contact in any health system. A strong and comprehensive primary health care facility can improve the healthcare access for the people and reduce the load in tertiary hospitals, not just by treating ailments, but also with preventive and promotive health care. Even though Shimla’s medical college and zonal hospital are within 5-6 kms from these two settlements, the residents are compelled to go to these hospitals even for small health issues or ailments that can be tackled at primary health care level such as diabetes. There are many persons in these colonies who suffer from chronic ailments such as hypertension, and diabetes or from respiratory illnesses such as tuberculosis, skin diseases and pain in bones and joints. They do not have motorable roads near their houses and must climb up several levels to reach the main road and catch a vehicle. The residents of Krishna Nagar and Idgah colony are garbage collectors, daily wage labourers, and small vendors, many of whom are migrants from other states or within the state. Families lose one- or two-persons’ daily wages (if the patient needs an attendant), having to spend money on travel, and medicines. These factors make the visit to hospital daunting, often leading to late diagnosis or loss to follow-ups. “Our elderly here have cases of blood pressure. Their blood pressure increases while they climb up the hill to reach hospital. We really need a dispensary here,” said a woman from Idgah colony. Take the case of tuberculosis diagnosis and treatment. Usually, the diagnosis as well as treatment of regular TB cases can take place in a PHC in India. Patients are often sent by primary health workers such as Auxiliary Social Health Activist (ASHA) workers, or Auxiliary Nurse Midwife (ANM). But the absence of a PHC snaps the link between the community and public health systems. An ASHA worker told us that a woman in her 50s died of TB last year in Idgah colony. She was diabetic that makes her more susceptible to the disease, and treatment tougher. By the time the lady sought proper treatment, it was too late. In Krishna Nagar, a 41-year-old man was diagnosed with TB did not to continue treatment in the government hospital, but wanted to consult private practitioner, presumably because it’s easier to access. When we asked an official from Integrated Disease Surveillance Programme (IDSP) about the health specific data of Krishna Nagar and Idgah colony, he told us that they don’t have settlement specific data. The lack of PHC also stalls surveillance in these areas. Primary health workers who are usually attached to PHCs have no health institution to directly raise concerns. Climate change To top this, climate change effects pose a huge risk for people in these settlements. People here already dread every monsoon, as they are at risk of landslides. In Idgah colony, the

Blog, Kenya

Access to clinics during floods in Matopeni

Can You Reach a Clinic When It Floods? Jane Njoroge It was 8 a.m. It was heavily raining in Mombasa’s Matopeni settlement. A young woman who has a walking disability had shida za mafua or chest complications in Kiswahili. She needed to see a doctor soon. But, it was impossible to use crutches in almost knee deep water. Her mother and brother had to carry her out of the house to go to the doctor. There were no ambulances, or bridges. During Mombasa’s rains, people living in its informal settlements have to brave the water, and the storm to reach any healthcare institution. They inevitably put off medical care because of the rains, and are often stranded and cut off from life-saving care. This woman spoke to me and my colleagues from Slum Dwellers International-Kenya (SDI-Kenya) during a Focus Group Discussion in the Urban Shade project where we are trying to understand access to healthcare during events like these in four coastal settlements in Mombasa, and Kilifi counties, including Matopeni. Matopeni settlement is located near the Kongowea market, perhaps the biggest market within Mombasa Island, where people mostly work. The settlement is on land owned by the local Municipal Council, with private players staking claim to it. During the April-May qualitative data collection, it was raining heavily. It emerged in our discussions that this lack of functional infrastructure exposes the residents of Matopeni to climate-related disasters. This limits their accessibility to healthcare facilities, with pathways impassable. The focus group discussions with various stakeholders revealed that this challenge is harder felt by vulnerable populations within the locality. Children, especially pre-primary children cannot cross these flooded pathways due to the high possibility of being carried away by the force of flash floods. As one resident put it, “During heavy downpour, the same pathways we use to access healthcare facilities are the same pathways used by water.” Matopeni during floods. Photo Credit: Muungano wa Wanavijiji, Matopeni. The disabled woman mentioned earlier said that her house tends to flood during heavy rains. As a result, she often catches flu and other ailments, and needs to see a doctor in her neighbourhood clinic. The adjacent pathways to her house are uneven and flooded, forcing her to rely on her mother and brother to carry her to the hospital. She said, “Flooded pathways are hard to navigate. I have to depend on my family to take me to the health facility. It is very hard to use crutches during flooding since the roads are covered by water, making visibility difficult, since the roads are not even and have potholes.” Uneven pathways that are not disability-friendly. The situation is further worsened when they become flooded, worsening visibility. It’s not just residents who can’t reach clinics, sometimes, healthcare providers themselves are unable to report to work due to damaged infrastructure, effectively shutting down essential services when they’re needed most. One respondent said, “When it rains heavily in the settlement, Kongowea dispensary also gets flooded. It is located on a flood plain. Sometimes even the medicines are carried away by the water. The government does not seem to bother, and nothing seems to change.” Kongowea Dispensary Health consequences are felt by the community during and after flooding. For instance, stagnant floodwater becomes breeding ground for mosquitoes, increasing the spread of malaria and other waterborne diseases. Stagnant water which act as breeding grounds Delays in treatment and care often lead to deteriorated health outcomes for the affected community members, especially for the most vulnerable groups. The community often crowdsources funds to arrange for a vehicle to take people who need urgent medical care, especially the elderly, disabled persons and people with underlying conditions to Tudor Sub County hospital. While this is heartwarming, it is neither always feasible or sustainable as a solution. There is a need to change this current situation in our informal settlements. The communities voiced thoughtful solutions during our focus group discussions. One such recommendation is the introduction of mobile clinics closer to the community to reduce accessibility time. At the moment, the communities have to travel for long distances, 3-5 kilometers, to get crucial and quality healthcare service. Transport to access this service has financial implications. There is a need for some major infrastructural changes in the community, especially in relation to the drainage system. An effective drainage system, and regular sanitation work to unclog waste can ensure more accessible pathways even during heavy rains. Flooded pathways and common areas in Matopeni Some of these problems can be taken care of by the community. A government initiative- National Hygiene Program dubbed Kazi Mtaani, a social protection programme that employs youth to help in clean up programmes in these settlements. The initiative started during 2020 in the thick of the COVID-19 pandemic in response to its major economic impact, especially on vulnerable communities. It is designed to help the youth living in informal settlements by providing them labour-intensive work for daily wages that can help create public goods for the community they live in including clearing garbage and opening clogged drains etc. A youth community member, actively involved in Kazi Mtaani scheme, said, “I have worked in that area during the Kazi Mtaani programme. I suggest an initiative to the youth to start collecting wastes at 20 shillings per household.” Policymakers, urban planners, non profits and communities need to connect climate change with health-related impacts, and prioritise inclusive, climate-resilient urban planning that ensures everyone, regardless of where they live, can access essential services, even during disasters. Infrastructure is not just about concrete and roads. It is about dignity, safety, and survival. No one should suffer life-altering health complications simply because they can’t reach help when it rains. Jane Njorage is an intern in the research department at SDI Kenya, and is currently pursuing Masters in GIS and Remote Sensing