Equity dimensions in initiatives promoting urban health and wellbeing in east and southern Africa

Abstract

Urbanisation in east and southern Africa (ESA) has brought opportunity and wealth together with multiple dimensions of deprivation. Less well documented in published literature on the ESA region are features of urban practice that promote health equity. This work thus aimed to explore features of urban initiatives aimed at improving health and wellbeing in ESA countries and their contribution to different dimensions of health equity. A thematic analysis was implemented on evidence gathered from 52 documents from online searches and 10 case studies from Harare, Kampala, Lusaka, and Nairobi. Most of the initiatives found focused on social determinants affecting low income communities, particularly water, sanitation, waste management, food security and working and environmental conditions, arising from longstanding urban inequalities and from recent climate and economic challenges. The interventions contributed to changes in social and material conditions and system outcomes. Fewer reported on health status, nutrition, and distributional outcomes. The interventions reported facing contextual, socio-political, institutional, and resource challenges. Various enablers contributed to positive outcomes and helped to address challenges. They included investments in leadership and collective organisation; bringing multiple forms of evidence to planning, including from participatory assessment; building co-design and collaboration across multiple sectors, actors and disciplines; and having credible brokers and processes to catalyse and sustain change. Various forms of mapping and participatory assessment exposed often undocumented shortfalls in conditions affecting health, raising attention to related rights and duties to promote recognitional equity. Investment in social participation, organisation and capacities across the initiatives showed participatory equity to be a consistent feature of promising practice, with both participatory and recognitional equity acting as levers for other dimensions of equity. There was less evidence of distributional, structural and intergenerational equity. However, a focus on low income communities, links made between social, economic and ecological benefit, and investment in women and young people and in urban biodiversity indicated a potential for gains in these areas. The paper discusses learning on local process and design features to strengthen to promote these different dimensions of equity, and issues to address beyond the local level to support such equity-oriented urban initiatives.

Socio-Economic Dynamics Inhibiting Inclusive Urban Economic Development: Implications for Sustainable Urban Development in South African Cities

“…These studies, among others, illustrate the factors affecting urban economic development in South Africa as it works towards achieving sustainable urban development. Moreover, research on solutions to rapid urbanization in South Africa has focused on curbing immigration, investing in rural areas [6,9,13,28], policy development and improved governance, and spatial inclusivity [57,62,67]. Recent studies have also focused on technology and innovation [58,77,79], and on social investment [65,70,73,74] as an alternative approach to various aspects of socio-economic and urban development.…”

“…Accordingly, Bandauko and Arku argue that the adoption of smart-city ideas in Africa must be rooted in contextual realities and properly designed to create urban spaces that are sustainable and inclusive [58]. For instance, a study by Loewenson, Mhlanga, Gotto, Chayikosa, Goma, and Walyaro [62] reported potential gains in urban development attained by focusing on low-income communities; links between social, economic, and ecological benefits; and investment in women and young people, as well as urban biodiversity. This implies that the entire value chain of urban development, whether within formal or informal dimensions, must be considered to optimize planning, enable economic growth, and improve the sustainability of the required resources.…”

“…This is because the processes of urbanization and industrialization are socially, economically, and politically mediated and may not automatically improve the livelihoods of city residents if they are not supported by progressive legislation. Policies that support people who are organizing themselves and advocating for the securing of a better life, conducive working conditions, and access to well-located land for settlement are necessary for sustainable and inclusive urban development in South Africa [62]. These pro-people policies premised on constitutional rights can help to promote decent urban living conditions, especially when supported by social investors and with sufficient government resources.…”

Socio-economic Dynamics Inhibiting Inclusive Urban Economic Development: Implications for Sustainable Urban Development in South African Cities

“…It is for these reasons that Bandauko and Arku argue that the adoption of smart city ideas in Africa must be rooted in contextual realities and properly designed to create urban spaces that are sustainable and inclusive. For instance, a study by Loewenson, Mhlanga, Gotto, Chayikosa, Goma and Walyaro [59] reported potential gains in urban development by focusing on low-income communities, links between social, economic, and ecological benefits, and investment in women and young people as well as urban biodiversity. This implies that the entire value chain whether from formal or informal dimensions must be considered to optimize planning, enable economic growth, and improve the sustainability of the resources required.…”

Water, sanitation and hygiene at sex work venues to support menstrual needs

“…Urbanization is projected to reach 62% of the population across sub-Saharan Africa by 2050 ( 1 ). Interventions have been initiated to address urban stress, deprivation, and structural inequities but most face contextual, socio-political, institutional, and resource challenges ( 2 ). Inadequacies in water, sanitation and hygiene (WASH) facilities in living and working environments and related exposure to health hazards is a major consideration ( 3 ).…”