In Sierra Leone’s capital, Freetown, urban growth is characterised by rising poverty and the proliferation of informal settlements including slums. The concentration of poor and marginalised groups in squalid living conditions with limited protective infrastructure and services. Residents in much of the slum settlements suffer disproportionately from poor health owing largely to their living conditions. As the Ebola outbreak showed, it is the existence of a large proportion of city residents in such neglected conditions that contributed to their increased risk of the disease.
While slums and other informal settlements in Freetown are sometimes provided with formal health care, it is not clear whether the care services that they receive are appropriate, affordable and of quality. Moreover, while data on population health is generally poor for all social and economic groups in Sierra Leone, residents in much of the Freetown slums as well as their living and health conditions are rarely given attention in official health statistics. The lack of information on the health condition of slum settlements prevent a clear identification and understanding of the problem and the kinds of policy and programmatic actions required to deal with the problem (Baqui, 2009).
As more studies continue to highlight the need for countries to not only tackle health inequalities of populations but to also take actions on the urban health determinants posed by the environment, including taking actions on such important global development agendas as the SDGs, there is need to develop a sound understanding of both the living conditions and the level of deprivations of people in informal settlements and how these affect health outcomes in the city.
FHS Extension Phase
Future Health Systems is carrying out a scoping study to identify and appraise the current state of knowledge on health systems and services in Freetown. By developing a better picture of knowledge, skills and capacity gaps, it is hoped that future analysis can focus on the extent to which degrees of poverty and deprivation influence urban health inequity in terms of access to health services and how the environmental condition of settlements can influence health outcomes of slum populations and their wider implications for the city of Freetown.