Scoping study on the urban health situation in Sierra Leone: A study funded by Future Health Systems (FHS)
There is growing concern in recent times about the health burdens faced by urban populations, particularly by those living in informal settlements in Sierra Leone. Many informal settlement dwellers face a variety of health risks which are exacerbated by the rapid urbanization of cities and the subsequent overcrowded living condition of settlements. Though rapid urbanization has negative effects for all in Freetown, those in low-income and disadvantaged groups are disproportionately affected.
Unfortunately, official health statistics and surveys often do not capture sufficient detail on the range of health problems faced by the urban poor who live in slum-like informal settlements. Many health surveys collect data on an aggregate level and are not specifically designed with the urban settings in mind. The lack of disaggregated data on the different informal communities and their residents suggests that appropriate policies which clearly reflect the different demography and health situations may not be in place. Given the dearth of information on how slum living conditions are likely to impact health systems and exacerbate care-seeking barriers, this study was undertaken to provide insights on the current state of knowledge on urban health situation in Sierra Leone. The specific objectives included the following:
- To identify, describe and appraise existing research on urban health in Sierra Leone, with particular attention to informal settlements.
- To identify existing policy frameworks for urban health, and to map the range of institutions involved in urban health service delivery in Sierra Leone.
- To identify gaps and set a research agenda for SLURC’s urban health programme.
The rationale of the study is to provide baseline information on the state of knowledge on urban health regarding informal settlements in Sierra Leone. The study used a desk review to appraise and analyze available documents on urban health in Sierra Leone. Documents were reviewed using an analysis framework to classify key issues discussed in the texts, gaps in literature, research findings and the methods adopted by the research. Prior to this, a selection process was undertaken to ensure that documents were carefully chosen based on a set criteria. Overall, 44 documents (35 publications/ reports and 9 health policies) were included in the review. Two workshops held with stakeholders allowed the validation of findings including the identification of additional information which, hitherto, were not included in the study.
A majority (69%) of documents reviewed focused on urban health issues in Freetown. This is likely because of the growing environmental problems in the city, rapid urbanization, and the proliferation of informal settlements. Moreover, whilst the review found the use of aggregated data to be more common, the reports did not provide clear understanding of the health challenges faced, the varying burden between different populations and geographic areas, and factors that magnify health risks. While some documents presented barriers to health services as an inherent characteristic of the health inequalities in Sierra Leonean cities, most studies presented health risks in the context of poor environmental and household sanitation, air pollution, and water contamination. The barriers to careseeking were examined under three main categories as follows: socio-cultural, economic, and health infrastructure. Other significant gaps in the reviewed documents were information pertaining to youths and the disabled. Overall, the review found that studies on urban health in Sierra Leone are relatively few. The need to fill urban health research gaps in Sierra Leone is evident, as there is a wide range of health issues needing inquiry. Gaps in knowledge relate mainly to the depth and types of issues prioritized for the study, compounded by study scale and methodology.
Additionally, the review found that there are several existing health policies in relation to urban health in Sierra Leone. However, more attention seems to have been given to improving the amount and quality of health care delivery, and increasing health care access for poor and vulnerable residents. While it was difficult to quantify health organizations involved in urban health in Sierra Leone from the list of documents reviewed, the stakeholder workshop showed that in Freetown, there are over sixteen such organizations intervening in informal settlements. However, it was pointed out that overall, the outputs seem very low with very minimal impact on the communities.
Another key finding was that most health interventions are focused on cholera and diarrhoea response, nutrition and child care promotion, the promotion of safe sex, and the treatment of sexually transmitted infections. Moreover, it is found that while a range of actors provide urban health-related services, there is a lack of coordination between stakeholders, with quality standards for providing health services often not being met.
With regard to setting its research agenda, it was suggested by the different stakeholders that SLURC not only address the research gaps identified in the review but that the center also disseminate information to stakeholders, helping them to intervene in informal settlements in a way that is appropriate and addresses community priorities.