Since 2007, more than 50% of the world‘s population is urban and in SSA, urban population is currently 37%, but estimated to grow to over 60% by 2050. Cities are attractive because of its offer of greater amenities, better employment opportunities and better services. However cities also concentrate risks and hazards for health. Today, 2/3 of urban dwellers in SSA are living in slums or slum-like conditions and Kenya typifies SSA’s urban crisis.
With an estimated 5% annual growth in Nairobi’s slum population, about 60-70% of Nairobi residents live in informal settlements or in slum-like conditions, characterized by limited access to water and sanitation, overcrowding and poor housing conditions, limited employment opportunities and the near absence of the public sector. Under these circumstances, the long held view of urban advantage in opportunities and health outcomes still holds for urban areas has increasingly come under scrutiny, raising intricate social and economic policy questions.
A typical road in Viwandani slums, Nairobi.
However, answering the question of whether the urban advantage still holds, require adequate data at the local urban levels, which are generally lacking. Existing national estimates do not sufficiently answer questions critical to the health and livelihoods of the urban poor, who constitute the majority of city dwellers. In response to this need, the Nairobi Cross-sectional Slums Survey (NCSS) was designed and implemented in 2000 by African Population and Health Research Center, which documented population and health indicators among the residents of Nairobi’s slums, and compared these with indicators from national surveys for other sub-groups of the Kenyan population.
The 2000 survey brought to light the plight of slum residents in Kenya and brought to focus the excess mortality and disease burden among the urban poor compared to any other subgroup in the country; their limited access to health care and family planning services; and the debilitating environment that characterizes their physical living conditions; including inadequate access to water and sanitation, poor housing condition, poor livelihood opportunities and the near-absence of public sector services.
Following investments by the Government of Kenya (GoK) and her development partners, together with the global push to achieve the MDGs, with particular focus on the urban poor, and evidence from the 2008/09 Kenya Demographic Health Survey (KDHS) that the various intervention programs were yielding positive results across the country, APHRC conducted the second Nairobi Cross Sectional Slum Survey (NCSS) in 2012, to examine change and continuities in the population and health conditions of the Nairobi urban poor across all slum settlements in the city.
Objectives of the study
The overarching question of NCSS 2012 was to determine whether investments by local and national governments and development partners in the past decade improved health and economic outcomes for the urban poor. The survey took stock of the changes that had taken place since 2000. Specifically, the study was guided by three key questions: Are the needs of the slum-dwellers still the same? What has really changed since the last report? What are new areas of focus to improve the well-being of the slum-dwellers? The overarching goal of NCSS 2012 was to strengthen the evidence base to guide policies and programs aimed at improving the wellbeing of the urban poor.
Generally, the NCSS 2012 results highlight marked improvements in environmental, health and educational indicators among slum dwellers. However, improvements were not uniform across slums, and subgroups, with slums in Central Nairobi, younger women and those without formal education consistently disadvantaged. Specifically, while old concerns in 2000 around employment, lack of access to water and sanitation, access to education and housing remained, they have shown remarkable improvements in 2012. Notwithstanding, water and road concerns have grown beyond their 2000 levels.
Yet, new concerns around garbage and sewer disposal and insecurity that were not cited in 2000 have emerged among the major needs for slum residents in 2012. Despite decrease in concerns about employment, explained by the emergence of new concerns around waste and garbage disposal and insecurity of life and property, unemployment for women increased from 41% in 2000 to 52% in 2012. For men 16.6% were not working at all in 2012. Moreover unemployment was higher for women 20-24 at 61.6% and 22.2% for young men of the same age. It is important to underscore that most of the employment among slum dwellers are in the fringe with little or no security. Among employed women, only 14% are in formal employment, while a whopping 86% are informal workers-own business, casual workers and urban agriculture among others. For men 18% are in formal employment- formal salaried, while 82% are in informal employment-formal casual, informal salaried-gardeners, own business, casual workers and urban agriculture In terms of water and sanitation, the survey found substantial improvement.
The survey recorded dramatic fall in purchase of drinking water and huge increase in access to piped water from public taps. While slum dwellers who buy drinking water declined from 75% in 2000 to 11% in 2012, those who access drinking water through public taps increased dramatically from 2.7% in 2000 to 59.3% in 2012. However the inequity between slum dwellers and non-slum dwellers in Nairobi remain with only 3% of non-slum dwellers buying water and 13.4% accessing drinking water through public taps as 78% of residents of non-slum Nairobi have water piped into their residences. There was also an increase in the proportion of flush toilets users and a decrease in the usage of traditional and ventilated pit latrines.
Remarkably, HIV/AIDS infection was less of a concern, a trait that can be attributed to aggressive media campaigns and the low cost of purchase and high accessibility to condoms. Increased testing and counselling for HIV was also identified as a major contributor to HIV prevention, treatment, care and support. The survey identified the great role of mobile clinics in bringing HIV testing advantage to slum dwellers. Progress on the education front was reflected by the increase in school participation among young people living in slums between 2000 and 2012.
The gap in the educational attainment between male and female school-age residents in the slums also narrowed among young people aged 12-14, but female disadvantage in access to education emerged from ages 15 and above, reflecting the hindrances young women face in transition to higher education occasioned by challenges related to early marriage, early childbearing, childrearing and poverty. What also came out clearly was the persistent educational disadvantage of slum dwellers relative to their non-slum counterparts.
Other areas of improvements in the slums in the last decade includes increased immunization coverage, higher access to health facilities for delivery and decline in under-five mortality. Notwithstanding, these improvements are not uniform across the slums of the city, with disadvantages persisting across slums and sub-groups and the overall disadvantages of slum dwellers persisting relative to non-slum dwellers.
The number of slum dwellers will continue to grow and building resilient cities and meeting national development goals will require sustained investment in improving the lives of urban dwellers, particularly the most vulnerable segment of the urban population. This study provides valuable perspectives on existing and new areas of focus that will be of significant value to policy makers and development partners whose programmatic focus is aimed at improving the wellbeing of the urban poor. Investment in research and data systems at local levels will be an important component of the push to address urban challenges moving forward, especially in monitoring and evaluation of interventions and in determining what works and otherwise.