Covid-19 and crowded urban settlements: how can we stop the spread?

Themes: Behaviour change Health impact Hygiene Planning Sanitation Water
Countries: Bangladesh Bangladesh-local Ghana Ghana-local Kenya Kenya-local Madagascar Madagascar-local Mozambique Mozambique-local Zambia Zambia-local

By Sam Drabble, Acting Head of Evaluation, Research & Learning

For the one billion people living in informal urban settlements in the Global South, the spread of coronavirus poses an imminent threat that could prove catastrophic.

A range of factors makes transmission of the virus in these contexts more likely, and the potential impacts even worse than the huge toll now being felt in more developed economies.

One such factor is the very high population density: social distancing and self-isolation are practically impossible in contexts where multiple families share the same compound, cook food in a communal area, and walk the same narrow lanes.

This situation is exacerbated by lack of access to basic services: many of the people living in these communities must leave their premises just to collect water, or to use a toilet which they could be sharing with 10 other families – for which they will often have to queue.

There are many factors at play, and considerable uncertainty. But the fear is that once Covid-19 reaches these areas, the unhygienic conditions will cause it to spread even more rapidly than in Europe, United States and China.

Covid-19: message from our CEO

Like every organisation, WSUP is having to react quickly to this constantly evolving crisis. In most locations where we work, social distancing is now in force. Cities are in lockdown, to varying degrees. All WSUP staff must work from home and cannot for now interact in person with those we exist to support.

But by continuing to work closely with our partner utilities, and with our wider networks at the city and national level, we can still make a difference: to the prospects of the people living in vulnerable communities, and to the people whose job it is to keep these communities supplied with basic services.

Beira, Mozambique. High population density and a lack of access to basic services means coronavirus poses a dire threat across urban areas in the Global South.

We have identified five priority areas in which WSUP and our partners can contribute in the cities where we work:

1. Hygiene promotion campaigns

An effective response to Covid-19 is dependent on clear information and advice. Getting the message across in informal settlements will require a sophisticated and targeted communications strategy. Information flows in these areas can be different from elsewhere, with local groups and community-level structures playing a central role. Community leaders will be critical in driving a crisis response, including local chiefs or councillors.

In Ghana for example, information about the virus has primarily been shared through key mainstream TV and radio outlets, but many people living in informal settlements will get their news from local radio stations serving anywhere between 5,000 – 15,000 people.

As a sector, we need to engage these outlets to ensure the information they relay is aligned with approved messaging from Ministries of Health and with wider government policy in relation to the virus.

Evidently strategies must be adapted to leverage specific cultural norms. In Bangladesh for example, select high-profile celebrities (notably members of the national cricket team) have huge traction with all segments of the population, and could potentially be engaged to push the cause.

2. National urban planning and coordination

Many African governments have been decisive in their immediate response to the crisis, requiring citizens to practice social distancing. The challenge now is to ensure institutions come together to ensure an effective nationwide logistical response.

In several countries where WSUP works, lines of responsibility within the public sector are unclear, and intermediaries can play an important role in supporting coordination. Taking Kenya as one example, this will entail our working in close partnership with a wide range of institutions, including the Ministry of Health, Ministry of Water and Sanitation, urban water utilities, the National Emergency Coordination Committee, County-level heads of preventive and promotive health, and large and local businesses offering essential services.

In Ghana, our immediate priority is to engage the Ministry of Health and the National Commission for Civic Education (NCCE) to support a coordinated effort to disseminate information about Covid-19 at the community level.

In Kenya WSUP is working in close partnership with a range of institutions such as the Ministry of Health, Ministry of Water and Sanitation and urban water utilities to support our Covid-19 response.

3. Emergency water tankers and bowsers

To fight Covid-19 the World Health Organisation (WHO) has recommended social distancing, regular handwashing with soap and practicing respiratory hygiene. But for regular handwashing to be sustained, people must have access to a regular water supply.

Working with our partner utilities to achieve continuity of piped water supply is a core priority for WSUP at all times, but the crisis presents unique challenges, and utilities will struggle to meet the increased demand in some parts of the city.

We need to supplement long-term water provision efforts with emergency water supply systems, including through water tankers and bowsers.

Here an example to follow is Nairobi City Water & Sewerage Company: the utility recently announced plans to drill boreholes to boost supply to Nairobi’s informal settlements, where tankers are also now widespread. We are hopeful similar measures will be introduced shortly in Lusaka and other locations.

4. Delivery and distribution of soap and handwashing facilities

As well as water, it is of course critical to ensure the residents of informal settlements have access to handwashing stations and plentiful supplies of soap. This is an area where the private sector has an important role to play, with Unilever and others now exploring ways to accelerate provision of soap and hand sanitizers to vulnerable communities.

In collaboration with these organisations — and as part of ongoing support to our partner utilities — WSUP is helping to identify priority locations in informal settlements so that simple handwashing facilities can be provided and donated soap or sanitizers can get to those in need. This will focus on areas that can offer the most benefit to communities such as local health centres, schools, water kiosks and public toilets.

In Kenya, our partner Nakuru Water has been installing handwashing facilities:

5. Provision of personal protective equipment

In countries where Covid-19 has already taken hold, appreciation has grown for the role of “key workers” – people whose jobs are considered vital to public health and safety. Water and sanitation are basic services and utility workers have an important role to play in crisis mitigation. In a major recent survey, water utility leaders in the United States cited potential staffing shortages due to illness and quarantine as by far their biggest current concern in the pandemic. Utility leaders across Africa and South Asia will share the same fears.

To maintain a regular supply, a portion of utility staff will have to stay mobile, for example to perform urgent service repairs in informal settlements. To protect these individuals, we are working with partner utilities to promote the procurement and provision of Personal Protective Equipment (PPE).

Acting with the required urgency

WSUP is well-positioned to support crisis mitigation efforts in informal settlements: many of our projects are explicitly focused on these areas, and our operations are built on close working partnerships with the city authorities and utilities mandated to serve them.

But neither we nor anyone else have all the answers – there is just too much uncertainty about how the virus will behave in these communities.

The key point at this moment in time is to identify those activities we know can make a difference, and to move and move quickly. We have a limited window of opportunity to mitigate the devastating effects of Covid-19 taking hold in communities where people are at the greatest risk.

Find out more about WSUP's coronavirus response