The rapid pace of urbanisation in most countries in Africa makes urban environments a major determinant of population health. In Freetown, urban growth is associated with the proliferation of informal settlements/slums owing largely to the prevalent poverty, overcrowded and filthy living conditions. Therefore, health outcomes are generally worse with intermittent disease outbreaks which can sometimes spread beyond a single neighbourhood to overwhelm the entire city. But, while a number of studies have documented evidences on the urban health situation in Freetown, such studies have not sufficiently explained the specific and community-wide health risks that people in each informal settlement are faced with. The study describes the living conditions in informal settlements, and explore how these relate to the health of people living there, as told and understood by the residents themselves and as reported in routine statistics.

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.

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.

Unequal access to healthcare exacerbates poor health due to their living conditions of those living in informal settlements across Freetown, Sierra Leone. This issue brief provides an insight into the current state of healthcare provision in Freetown’s informal settlements.

Waste management has been a challenge in the Freetown municipality of Sierra Leone for a long time, underpinned by the limited capacity of institutions responsible for waste collection and depositing. These challenges come with a huge cost to human health. The situation is even worse for people living in informal settlements within and on the fringes on the city. The lack of a well-planned and regulated waste management system in the informal settlements is a key driver of indiscriminate waste dumping. Waste dumping by communities, mostly in waterways, drainages and under footbridges, are invariably linked to health challenges for informal communities and built-up settlements located alongside those communities. This issue brief therefore provides an insight into the current state of waste management challenges in informal settlements.

Access to water is one of the major challenges faced by residents of Freetown, Sierra Leone, and informal settlements are no exception to this problem. Communities’ sources and access to water vary by location. The rapid urbanisation and over population is part of the reasons for the water crisis in the city as the estimated beneficiaries far outweigh the capacity of the national Guma valley water company that is responsible for water supply in the city. The topography of the lands occupied by informal settlements makes their situations even worse to get access to safe drinking water. This issue brief provides an insight into the current state of water and sanitation challenges in informal settlements.