GCRF Accountability for Informal Urban Equity Hub

Lead Research Organisation: Liverpool School of Tropical Medicine
Department Name: International Public Health


More than half of humanity currently lives in urban areas and 68% are projected to do so by 2050. One in three urban dewllers, and an estimated 881 million people in Low and Middle-Income Countries (LMICs) now live in informal settlements, colloquially known as 'slums', where they have inadequate, insecure housing and limited services. These settlements are often the only option for people working in the informal sector, and existing evidence shows that residents are often highly resourceful, resilient and innovative in navigating the problems they face daily. However, they also face challenges that appear intractable: multiple health and well-being risks and vulnerabilities, related to an unhealthy environment, insecurity and social marginalisation. Informal urban settlements are rapidly changing, with in and out-migration and shifts in social norms, as well as being economically and socially unequal. Failures to provide services, infrastructure and mechanisms for redress by national and local governments are often linked to the presence of multiple actors and organisations including non-governmental, private and criminal organisations. These conditions can act as an incubator for various forms of violence (e.g. political and gender-based), which threaten well-being.

Our Hub will work with the most marginalised dwellers in informal urban settlements, including through federations of 'Slum/ Shack Dwellers', linked to Hub partner SDI. We will support them in identifying their priorities, making their conditions visible to key service providers related to health (both governmental and non-governmental) across a range of sectors, and working with identified allies amongst these actors to develop better mechanisms for accountability and more responsive services. We will test this approach to addressing this intractable challenge, and pilot the priority interventions developed. Many conventional research methods and routine information systems are ill-suited to these complex and rapidly changing contexts and are not sufficiently linked to action. We will use innovative participatory methods, including analysis of data collected by informal urban dwellers themselves, to gain a deep understanding of health risks, vulnerabilities, and priorities and service access barriers. We will bring insights from a range of disciplines including social and political sciences and epidemiology to develop innovative metrics that can better reflect these realities and inform policy and practice development and evaluation.
Learning and data from these innovative approaches and methodologies will be brought together to form a tested set of methodologies that identify promising mechanisms for improving accountability and service responsiveness to promote health and well-being for the most marginalised. We will communicate the new concepts, evidence and methodologies to national, regional and global governmental and non-governmental organisations through our networks and partnerships to maximise the potential for improved policies, strategies and services.
Our Hub is uniquely placed to realise our vision. We bring together partners with long standing relationships, and develop new collaborations that add value in terms of expertise and networks. IDS and University of Glasgow bring core strengths in participation and urban governance; epidemiology and inter-sectoral action respectively. LMIC partner institutions have strong national, regional and global influence and reach, including with informal urban dwellers (e.g. SDI and APHRC), with national and international non-governmental organisations (e.g. LVCT Health, BRAC ) and with national governments (e.g. COMAHS, SLURC, The George Institute). LSTM has an outstanding track record in leading successful multi-partner collaboration for health impact. We will collectively build interdisciplinary capacities across the Hub and use this learning to benefit the next generation of researchers.

Planned Impact

Our Theory of Change anticipates impact across three domains - understanding, relationships and action - and at three levels - local, national and global.

At the local level, marginalised informal urban dwellers in study sites in Bangladesh, India, Sierra Leone and Kenya, and beyond through our responsive challenge fund, will benefit through:
a) Understanding: Research that builds their capacity to analyse their own well-being and health, priorities and potential allies for action, and opportunities to make demands to key actors in governance arrangements, as the basis for developing accountability mechanisms;
b) Action: Design and piloting of improved accountability strategies, mechanisms and more responsive services in local study sites to promote their well-being and health.
c) Relationships: Development of committed, trusting relationships and alliances with key governance actors will that will extend beyond hub programmes, with continuing impact

Our partners have demonstrated the benefits of such work with informal urban dwellers, and this is a core competency of Slum and Shack Dwellers International (SDI), who have driven changes in the recognition of informal settlement dwellers that have resulted in improved state provision in India.

At the local level, providers (formal and informal) of health-related services across different sectors, will benefit through participation in defining priorities and interventions for more accountable and inclusive services. For example, in Bangladesh's highly pluralistic health system, BRAC has worked in informal settlements to broker partnerships between formal and informal providers for referral for improving the quality of menstrual regulation services, which are a priority for poor, urban women.

At local, national and global levels, government stakeholders such as city authorities, and Ministries for health and urban planning, and non-governmental (not for profit) organisations with a remit to provide services to informal dwellers will benefit through:
a) improved relationships with urban informal dwellers;
b) improved understandings of their realities, challenges and resilience;
c) relevant tools and approaches for systematic action to improve their well-being.

We will promote these impacts through strong partner linkages to governmental actors, and non-governmental programmes (such as BRAC Urban Development Programme in Bangladesh, LVCT Health programmes in Kenya and BRAC International programming). BRAC urban development programme has expressed a strong demand for the research.

At the global level, marginalised informal urban dwellers beyond the study sites in LMICs will benefit through the reframing of debates on urban informal health and well-being leading to new conceptualisations and step changes in policies at global, regional and national so that these better reflect and respond to local realities. Our partnership is uniquely placed to achieve this impact. Partners have demonstrated how their approach can be taken to scale nationally and globally. For example, work by the SDI federations alliance in India has led to both city sanitation policies and state policies for relocation of slum dwellers affected by urban infrastructure projects. The railway relocation process in led by SDI in Mumbai also produced templates for similar relocation process in Kenya. We are also well-placed to influence global level discourse and policy. For example, Sheela Patel (SDI) sits on the highly influential UN Habitat working group, and LSTM convene the Health Systems Global Thematic Working group on Health Systems in Fragile and Conflict Affected states. The IDS-led Ebola Platform for Action brought together key partnerships to ensure maximise impact from learning and was awarded the prestigious (ESRC) Outstanding International Impact Prize. COMAHS have strongly influenced the health reconstruction agenda in Sierra Leone both post-war and post-Ebola.


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