Urbanization in East Africa: Stakeholder Perspectives on Key Challenges
People are moving from rural to urban areas at unprecedented rates throughout the world, and nowhere will this phenomenon continue occurring more rapidly than on the African continent. Although only 40 percent of its population currently live in urban areas, that figure is expected to reach 56 percent by mid-century, as Africa is on track to becoming the fastest urbanizing region from 2020 to 2050.
What will this dramatic shift mean for the health of vulnerable populations in Africa? A growing number of poor youth and adolescents on the continent represent those hardest to reach and most at risk. As growth outpaces the current capacity to plan and provide quality health and social services how will we ensure their healthy development? While scholars and practitioners alike may disagree on whether urban, peri-urban, or rural areas are healthier, urbanization undeniably presents new, complex challenges for those interested in improving health outcomes among vulnerable populations.
To better understand and address these challenges, a broad range of stakeholders from East Africa have engaged in critical conversations to determine implementation science priorities to advance the health of poor urban youth and adolescents. The first coalescing of these conversations occurred during a regional consultation hosted by East, Central and Southern Africa Health Community (ECSA-HC) in Dar es Salaam, Tanzania in June 2017. Colleagues from implementation, policy, donor, and research institutions, as well as local and national government representatives from across the East African region, zeroed in on urban nutrition and water, sanitation, and hygiene (WASH) challenges in urban contexts. In addition to discussing relevant priorities, participants emphasized the need for deliberate collaboration on efforts to ensure communities or beneficiaries are involved in the identification and framing of implementation research questions. Participants also emphasized the need for a platform that engages sectors beyond health to facilitate integrated, comprehensive responses to urban nutrition and WASH challenges.
Building on the regional consultation in Dar es Salaam, the HEARD Project hosted an organized session at the 14th International Conference on Urban Health in Coimbra, Portugal. The session was moderated by Yoswa Dambisya (ECSA-HC) and speakers included Prea Gulati (Look at Us!), Masuma Mamdani (Ifakara Health Institute), D. Okello (Kampala City Council Authority), Jane Mumma (Great Lakes University of Kisumu), Tolullah Oni (University of Cape Town), and Jennifer Wisdom (City University of New York). The panelists’ remarks and discussion crystallized the need for an integrated approach to improve health outcomes since, as Masuma Mamdani emphasized: current data provides a “disease” picture but does not move beyond typical indicators to incorporate mental and social health, the understanding of which is fundamental to understanding urban wellbeing. Jennifer Wisdom added that critical to an integrated approach is the inclusion of areas of government beyond health departments in the leading of health policy development. Indeed, broad government engagement in policy formulation appears to be related to higher buy-in from partners at the time of implementation.
The discussions in Dar es Salaam and Coimbra represent an important step in the direction of bringing key stakeholders to the table to work together towards prioritizing the health of poor urban youth and adolescents in East Africa. By leveraging its partnership of thirty-three institutions dedicated to advancing the work of implementation science in global health, the HEARD Project intends to continue facilitating broad stakeholder engagement to address the complex challenges urbanization poses for the health of vulnerable East African communities and beyond.