Informal settlements are at high risk of becoming hotspots of the novel COVID-19 virus. Recent estimates show that one billion people live in informal settlements across the globe.
It is projected that people living in informal settlements will increase to two billion by 2030 and to three billion by 2050, especially if current trends persist. In Africa, about 61.7 percent of the population resides in informal settlements, while it is estimated that 72 percent of urban dwellers in sub-Saharan Africa live in informal settlements. In Ghana, approximately 4.8 million people in urban areas live in informal settlements, that is 45 per cent of the country’s total urban population.
In Accra, with an estimated population of 4.5 million people, approximately one-third of the city’s residents live in informal settlements. In their 2016 research “Know Your City”, Peoples Dialogue, counted 265 informal settlements in the Accra Metropolitan Assembly (all the ten sub-metros of which seven are now municipal assemblies) alone. You can extrapolate this to the Greater Accra Metropolitan Area in addition to Kasoa and Greater Kumasi Area which are under partial lockdown and your guess is right. For instance, Fadama, Ghana’s biggest informal settlement has between 55,000 and 79,000 dwellers. Other informal settlements and crowded places include Agbogbloshie, Avenor, Chorkor, James Town, Teshie, Nungua, Nima, Madina Zongo, Alogboshie, etc (in Accra) and Alaba, Aboabo, Moshie Zongo, Akwatia Line, etc in Kumasi.
Most people who live in these areas in Ghana have no or limited access to basic facilities and services such as water, electricity, sanitation, housing, health, and security. These conditions contribute to poor health outcomes and the likely outbreak of diseases among the dwellers. Again, due to the poor sanitation conditions in these settlements, a notable disease in these spaces is cholera. With these challenges facing informal settlements in Ghana, the COVID-19 pandemic poses a serious threat especially to people living in these informal settlements across the country.
The current mitigation strategies put in place to “flatten the curve”- prevent and delay the spread of COVID-19 including physical distancing have continued to prove difficult to enforce in informal settlements because of their crowded nature. Moreover, structural barriers such as inadequate water and sanitation impede their ability to adhere to the prescribed hygiene measures to curb the spread of the disease. In informal settlements, there is a higher likelihood of infection because of the difficulties to practice both physical and social distancing. Numerous structural and socio-cultural factors including, inter alia, queuing to use shared toilets or draw water from wells or boreholes, crowded public transport system, narrow lanes, limited public education on dos and don’ts would heighten the risk of exposure.
Currently, the government of Ghana has recognised the potential of COVID-19 to spread like wildfire should it find its way into informal settlements. Hence, several strategies and interventions have been rolled out to support informal settlement dwellers and the poor. This includes the distribution of meals and dry food, free water and a 50% reduction in electricity bills. Whereas these measures are welcomed and will go a long way to support informal settlements, there are few challenges in the delivery of these supports. First, people are often crowded in trying to access these freebies — meals and dry foods. Second, most informal are not connected to pubic pipes or water supply systems. The non-existence of this essential service that is being subsidised means that the existing inequality gap is widened worsening the vulnerability of those most vulnerable to the pandemic.
All over the world, informal settlements are overly crowded. It is rather irrational to assume that physical distancing and social distancing could be practiced in such an environment. Indeed, if the current epidemiological evidence is that COVID-19 is spread through human to human contact then there is no gainsaying that informal settlement is a recipe for disaster and the implications are deeply worrying. In fact, informal settlements are critical in the fight against the COVID-19 pandemic and its containment. Therefore, I urge health and city officials to jealously guard the many informal settlements in the partial lockdown areas or else we risk losing the battle against COVID-19. In addition to the interventions by government, I propose some ideas for consideration:
Tailor-made narrative and messaging
Whilst governments and health authorities are striving to limit widespread infections, awareness creation for informal settlements should be tailor-made. Education messages must be appropriate to their audience. In other words, the messaging should respond to their concerns, take account of available resources, use media that informal settlement dwellers use, and counter false information. The government should quickly assembly informal settlement experts to painstakingly design context fit messaging and social protection schemes to help prevent any potential spread in informal settlement. There are numerous actors such as Peoples Dialogue, Ghana Federation of the Urban Poor that the government could quickly call upon to assist in delivering this task. This approach will transmit trust and quick community buy-in.
Use community leaders and NGOs
Community leaders are best placed to advice on the appropriate measures that might be accepted by informal settlement dwellers. This is particularly important in informal settlements where the state has limited legitimacy and capacity. Such figures may include local chiefs, religious leaders, traditional healers or youth group leaders. Most informal settlements have some form of community-based organisation or residents’ association, and the acceptability of COVID-19 control measures will be greatly enhanced if they have the support of these groups. Community leaders can play a role in disseminating education messages, identifying and isolating suspected cases, enforcing rules such as social distancing in queues and limited movement between units, and distributing protective equipment such as masks, soaps, and hand sanitizers. They can also develop measures of their own, which may be more appropriate to the local context than broad-based policies developed by central governments.
Develop a roster system and limit entry & exit points
Temporary measures should be developed to limit the movement of informal settlement dwellers. Roster systems must be developed to reduce the number of members who go out to the market or to fetch water, dispose sewage, conduct mobile transactions, or use public transport. The number of entry and exit points to these informal settlements should be controlled and hand sanitizers, containers filled with water and soap could be placed at these entry/exit points with signs urging those who enter/exit to wash and sanitize their hands.
House informal settlement dwellers
All schools in the country have been closed. As a short-term measure, these schools can be used to house kayaye’s (head porters) who sleep on the street and some informal settlement dwellers who are willing to move out of their crowded settlements. I suspect there will be a lot of resentment to this action, but we must know that COVID-19 is a public health emergency and therefore unpopular decisions and sacrifices must be made if we are to win this war. Housing them in these schools comes with several advantages. First, they will be under total control and movement can be controlled. Second, they can adhere to the physical distancing rule and practice the prescribed hygiene practices proposed by public health experts. Third, it will help avoid the overcrowding and stampeding that is currently associated with sharing meals which have the potential to spread the virus should one of them contract it. Fourth, it will help in contact tracing should any of them be found to contract the virus.
Contextualisation
No two informal settlements are the same despite their similarities – differences exist between informal settlements in developing and developed countries, urban and rural and country to country. Policies including resource provision, educational messaging, and training and support for community leaders will only be effective if they are adapted to the characteristics of each settlement.
Conclusion
I think the most powerful asset that can be honed and harnessed in slums/informal settlements is resilience and self-organisation. Hence, an effective COVID-19 campaign model should be community-led that help identify their needs and tailor innovative low-cost solutions. The need to empower leaders of various factions and organizations ranging from traditional leaders, religious bodies/platforms along with youth and women organizers to effectively mobilize community members and train volunteers, with strong support from the local government is very urgent.
By Dr. James Kwame Mensah|3news.com|Ghana
About the author: A lecturer in the Department of Public Administration and Health Services Management at the University of Ghana Business School. He is also a fellow at the Penn Institute for Urban Research, University of Penslyvania.