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Living conditions and health links in Freetown’s informal settlements

Future Health Systems

Living conditions of people living in urban informal settlements are characterized by inhumane conditions, underpinned by lack of essential services like water and sanitation services including toilets and waste disposal dumps, housing and health services. The current state of service provision in Freetown’s informal settlements is in part a product of growing informality, in response to gaps in the provision of public services, notably in sanitation and health care.

This policy brief provides an insight into the current state of living conditions in informal settlements of Freetown and how these link to health. It is an outcome of a research work by the Sierra Leone Urban Research Centre (SLURC) in partnership with the Future Health Systems (FHS) in four informal settlements in Freetown to understand how living conditions relate to health.

The policy brief proposes the following recommendations and actions for policymakers:

  1. There is need to promote slum upgrading programmes which will be a deliberate effort to improve settlement locations as well as make them better serviced. All settlements are in need of better drainage systems, regular cleaning of waste from drainage channels, and enforcement of community bylaws on the compulsory provision of toilets for the houses built. This could be monitored by the sanitary inspection directorate at the Ministry of Health, and will reduce exposure to health risks like malaria, diarrhoea, etc.
  2. Provision of additional water tanks for communities that cannot dig or easily access pipe water because of either their location or terrain. Also, constant refill of water tanks provided by the government to ease the burden of distance and cost on community residents.
  3. Promotion of greater community planning would ensure sustainable land use for purposes like proper waste management, new healthcare facilities, and reduced overcrowding.
  4. Public health planning should be linked to helping residents understand and appreciate the benefits of seeking timely formal healthcare.
  5. Efforts should be intensified to increase access to formal healthcare, especially to people living in hard-to-reach areas including areas located far away from the nearest PHC. Public health planning should also prioritise access for the poorest, whose health is most affected by living conditions and for whom healthcare costs are the greatest barrier.
  6. Revitalise Community Health Management Committees (CHMCs) in order to improve communication between health facilities and communities, and ensure greater accountability of health providers to their clients. This should include greater transparency around drug supply and administration.