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Public Health Promotion in Urban Emergencies
1. Considerations for Public Health Promotion in Urban Areas Nicholas Brooks, Oxfam GB Health and Hygiene Promotion Forum Oxford, UK, 30 March – 1 April 2011
Hot topic – as IFRC said, is urban the new rural ? Standard urbanisation fact – pop growth, climate change etc vulnerability, medium sized cities. Oxfam – discussions on how to strengthen organisational urban skills the day before Haiti EQ. IASC – Strategic Objectives Develop Operational Strategies Strengthen Technical Surge Capacity Approaches and Tools for Urban Areas Protection of Urban Vulnerable Livelihoods and Economic Opportunities Preparedness UN Habitat – on-going projects, slums ODI/HPG Sudan, RSC Oxford (urban IDPs), WSUP
Technical . What do we know or assume about the hygiene practices of affected people in urban disasters? Picture shows latrine user removing her shoes at entrance to a latrine! Operational – the strategic approaches to PHP, the cross-cutting issues – e.g. public health needs assessments – complexity - picture shows screen grab from just 1 page (Delmas area) of 38(!!) in an inter-Cluster atlas of IDP locations in Haiti. Communities – strong emphasis on community-led approach – how suitable or adaptable is this in urban?
Collection of health data – disaggregated. Opportunities for PHP to add quality. Zimbabwe urban cholera nodes – rapid spread. WHO/UN Habitat – urban women 1.5* more HIV than men. Urban 1.8* rural women. Urban hygiene practices – handwashing – knowledge/availability of soap. Water availability – e.g. purchase, Haiti not using tankered water. Sanitation – Haiti poo bags. Nothing that can’t be found out through good participatory assessments – but need to recognise we are working in different environment, different socio-cultural characteristics – and not assume standard ‘key messaging’. ICT possibilities – established and modern - mobiles, radio, internet, advertisements, same old IEC – would be interesting to hear from this group, what has been tried, what works? Zim cholera – much use of SMS, radio, but limited evaluation of this. NFI distributions – token schemes, security / use community for liaison – Haiti examples. EFSL integration – managing cash for work, marketing POU Water Treatment, e.g. liquid chlorine.
Timely availability of disaggregated health data was one of the big challenges of Zimbabwe cholera – leading to NGOs/Govt chasing outbreaks round the country. Always behind the curve. This map shows cholera cases in Harare by suburb. Red and dark brown being the worse hit – coincides with low income, high density housing with weak coping mechanisms to respond to water shortages, poor sanitation etc.
Targeting – recognised by IASC as one of priority areas to improve. Multiple small camps. Affected persons: IDPs - host community – economic migrants (‘squatters’) e.g. Pakistan. Local partners – what are their skills? Options for partnering with non-traditional – e.g. Haiti, long-term (dev. orientated) engineering, water supply specialists – are there similar available, maybe community development orientated, for HP? All recent urban emergencies have shown up complexity of engaging with multiple levels of local govt. at both NGO and WASH Cluster level. Innovative partnerships – universities, private sector – supermarkets for NFI quick availability, token schemes etc. Political – e.g. in Zimbabwe OGB not able to organise public meetings (political implications) – obstacles to large-scale NFI distributions, mass messaging. Capacity building – or is it just better use of the established tools, programming with an open-mind?
Urban poor, or slum communities potentially stronger than better off urban residents, and strongly cohesive. Common argument against slum clearance. We shouldn’t dismiss them as poorly structured, just because it is difficult to see patterns (simplicity?) we see in rural areas. But what about urban communities at time of crisis / displacement? How quickly do groups reorganise? – relevance for community-led WASH responses. Worthwhile to note different urban displacement we may see in emergencies – I.e. rural-urban – Darfur / Pakistan floods, compared to intra-urban Haiti, Philippines. Are incentive / payment issues even more complicated in urban? “Urban people won’t work for free” (Zimbabwe). How do we reconcile fact that our ‘community’ leaders or WASH committees might also be gang leaders etc. Note – all more questions posed than clear answers! However more comparative analysis of urban PHP will surely reveal patterns.
WASH: WASH upgrading in schools and intensified hygiene awareness (UNICEF and NGOs), various approaches to emergency, portable water, toilet provision and waste management PHP tools – PRA, community mapping, transect walks. PHAST / CHAST. IRC Hygiene and Sanitation Software, 2010 , has useful study of what used where (rural, urban, peri-urban) Heard from colleagues yesterday about difficulties / limits for both CLTS and PHAST in urban – take this forward to the discussion
Wealth of information available on development / urbanisation. Good range of material on water and sanitation (more on hardware options, O&M). Much less, if anything (I’ve found) on PHP – specifically that deals with what is different about urban PHP (rather than textbook). Copies onto CD
