A Corridor of Contrasts: On the road from Abidjan to Lagos, urbanization offers risk and opportunity, hardship and hope, 2015. African Strategies for Health.

To document issues affecting the health of people living in urban areas along the corridor, the US Agency for International Development’s (USAID) Africa Bureau and Global Health Bureau commissioned African Strategies for Health (ASH) to capture the stories of people who live and work along the road.

In January 2015, a journalist and photographer traveled the route and interviewed USAID staff, private and public health service providers, USAID implementing partners, and urban residents. This report is a compilation of those stories and the recommendations made by people living along the corridor for improving services for those who need it most.

MIT/CITE – USAID: Evaluation of water filters in Ahmedabad, Oct 2015.

| Complete Report | Summary |

Background – CITE’s household water filter evaluation allowed us to study innovations with the potential to better the lives of India’s “water poor”—the 76 million people in the country who lack improved drinking water.

CITE teams studied over 100 models of householder water filters from nine major brands available on the market in Ahmedabad, India. These models fell into three main categories: conventional particle filtration (cloth/jali mesh), gravity non-electric filters, and reverse osmosis filters.

In Ahmedabad, MIT students and researchers worked closely with students from local Indian universities to conduct the evaluation. Another student team spent the summer in the Consumer Reports labs in Yonkers, New York conducting lab tests of the same models being tested in the field.

CITE used multi-criteria analysis and Consumer Reports-style rating charts to guide its water filter evaluation report, which was released in October 2015.

Key Findings


  • Cloth and jali filters are cheap and common among low-income users, but are not effective in reducing E.coli, or turbidity.
  • Gravity non-electric filters are moderately priced and far more effective than cloth filters at reducing E.coli and turbidity.
  • Reverse osmosis is a popular type of water filter system perceived as the best, but most of these systems are not an affordable option for the poor. Moreover, these filters generate wastewater at rates triples that of the clean water they produce—a negative environmental impact in a water scarce region.


  • Postponed assembly at the retail level for certain water filter products can be very effective in scaling the supply chain. The locally branded “Dolphin” reverse osmosis water filters assembled by the distributors and retailers are promising from a scalability perspective.
  • Water filters offer a good retail entrepreneurial opportunity since the assembly process is straightforward and requires few technical skills.
  • A low-priced water filter is not sufficient for reaching rural populations. The more affordable gravity non-electric models are not readily available in rural areas, where they may be needed most.


  • Water filter use seems to be dependent on use of water filters in the past and peer effects. This suggests that sustainable water use may be better suited to community- and neighborhood- scale interventions, rather than market interventions, at least in the short-run.
  • A majority of water filter purchasing decisions were influenced by the buyer’s close network, most often a family member.
  • Knowledge about household water filters designed for the bottom of the pyramid is low among that market segment. Technology adoption proves difficult when one’s peers do not have knowledge about a particular product.

Sanitation Service Delivery – Making Kumasi a Cleaner City, Sept 2015. Source: PSI Impact |

Sanitation Service Delivery (SSD) is a USAID/West Africa regional urban sanitation project that is implemented by PSI in collaboration with PATH and Water and Sanitation for the Urban Poor (WSUP). The project aims to improve sanitation outcomes by developing and testing scalable business models that engage private sector service providers and by contributing to the creation of a strong enabling environment for sanitation in West Africa. WSUP plays a vital role in supporting government partnership efforts to strengthen public support for improved sanitation and fecal sludge management (FSM) services in Ghana — an important aspect of the SSD.

Photo Credit: Dana Ward

Highlighting the important role governments will play in this endeavor, Dana Ward, PSI country representative in Ghana and chief of party for Sanitation Service Delivery (SSD) Project in Ghana, Benin, and Cote d’Ivore caught up with Anthony Mensah, director, Waste Management Department Kumasi Metropolitan Authority (KMA), about the city’s strategy to make Kumasi among the five cleanest cities in Africa.

In this Q&A, Anthony Mensah responds to questions on successes and challenges of the Kumasi program. Read the complete article.

Launch of “Strengthening Water and Sanitation in Urban Settings” project in Kolkata.

Kolkata, 12 August 2015: TERI University and the U.S. Agency for International Development (USAID) in association with Coca Cola and The Energy and Resources Institute (TERI) today launched the ‘Strengthening Water and Sanitation in Urban Settings” initiative in Kolkata. The WASH programmes (Water, Sanitation and Hygiene) aim to reach 50,000 beneficiaries in low-income settlements and over 300 professionals through WASH governance studies. It will also reach out to 2,500 students through 20 municipal schools across India.

The goal is to help achieve the Government of India’s sanitation targets by conducting a WASH risk analysis in slums of Kolkata and Chennai. As first steps, two urban neighbourhoods – Kannagi Nagar and Nedunchelliyan Nagar in Chennai, and areas in KMC wards 57 and 58 (Khayari basti, Arupota and Dhapa) in Kolkata – have been chosen for household surveys.

The project will assist in developing participatory intervention strategies in urban areas, and in building the capacity of faculty and students through a model sanitation curriculum.\

Read the complete article.

Urban Malaria: Understanding its Epidemiology, Ecology, and TransmissionAcross Seven Diverse ICEMR Network Sites. Am Jnl Trop Med Hyg, Aug 2015.

Authors: Mark L. Wilson, Donald J. Krogstad, et al.

A major public health question is whether urbanization will transform malaria from a rural to an urban disease. However, differences about definitions of urban settings, urban malaria, and whether malaria control should differ between rural and urban areas complicate both the analysis of available data and the development of intervention strategies. This report examines the approach of the International Centers of Excellence for Malaria Research (ICEMR) to urban malaria in Brazil, Colombia, India (Chennai and Goa), Malawi, Senegal, and Uganda. Its major theme is the need to determine whether cases diagnosed in urban areas were imported from surrounding rural areas or resulted from transmission within the urban area.

If infections are being acquired within urban areas, malaria control measures must be targeted within those urban areas to be effective. Conversely, if malaria cases are being imported from rural areas, control measures must be directed at vectors, breeding sites, and infected humans in those rural areas. Similar interventions must be directed differently if infections were acquired within urban areas. The hypothesis underlying the ICEMR approach to urban malaria is that optimal control of urban malaria depends on accurate epidemiologic and entomologic information about transmission


Entering the city: emerging evidence and practices with safety nets in urban areas, 2015.

Author: Ugo Gentilini, World Bank.

Most safety net programs in low and middle-income countries have hitherto been conceived for rural areas. Yet as the global urban population increases and poverty urbanizes, it becomes of utmost importance to understand how to make safety nets work in urban settings. This paper discusses the process of urbanization, the peculiar features of urban poverty, and emerging experiences with urban safety net programs in dozens of countries. It does so by reviewing multidisciplinary literature, examining household survey data, and presenting a compilation of case studies from a first generation of programs.

The paper finds that urban areas pose fundamentally different sets of opportunities and challenges for social protection, and that safety net programs are at the very beginning of a process of urban adaptation. The mixed-performance and preliminary nature of the experiences suggest to put a premium on learning and evidence-generation. This may include revisiting some key design choices and better connecting safety nets to spatial, economic, and social services agendas compelling to urban areas.

Interpersonal communication as an agent of normative influence: a mixed method study among the urban poor in IndiaReprod Health. 2015; 12: 71.

Authors: Rajiv N. Rimal, Pooja Sripad, et al.

Background - Although social norms are thought to play an important role in couples’ reproductive decisions, only limited theoretical or empirical guidance exists on how the underlying process works. Using the theory of normative social behavior (TNSB), through a mixed-method design, we investigated the role played by injunctive norms and interpersonal discussion in the relationship between descriptive norms and use of modern contraceptive methods among the urban poor in India.

Methods - Data from a household survey (N = 11,811) were used to test the underlying theoretical propositions, and focus group interviews among men and women were then conducted to obtain more in-depth knowledge about decision-making processes related to modern contraceptive use.

Results - Spousal influence and interpersonal communication emerged as key factors in decision-making, waning in the later years of marriage, and they also moderated the influence of descriptive norms on behaviors. Norms around contraceptive use, which varied by parity, are rapidly changing with the country’s urbanization and increased access to health information.

Conclusion - Open interpersonal discussion, community norms, and perspectives are integral in enabling women and couples to use modern family planning to meet their current fertility desires and warrant sensitivity in the design of family planning policy and programs.

Life in a landfill slum, children’s health, and the Millennium Development Goals. Sci Total Env, Dec 2015.

Authors: Tomoyuki Shibata, et al.

• Waste-pickers and the health and well-being of their children are examined
• Landfill slum (LS) residents do not have a share in improving economies
• LSs illustrate the interrelationship of Millennium Development Goals
• LS mothers and children are exposed to toxic chemicals and pathogens
• MDGs directly and indirectly addresses issues affecting LS children’s health
• Improved solid waste management will benefit LS resident health and well-being

People living in slums can be considered left behind with regard to national successes in achieving Millennium Development Goals (MDGs). The objective of this study was to evaluate the living and working conditions of waste pickers and their children in a landfill slum located in the largest city in eastern Indonesia. A total of 113 people from the landfill slum and 1184 people from the general population participated in face-to-face interviews. Municipal solid waste (MSW) was analyzed for metals, metalloids and fecal indicator bacteria. Ambient air quality including particulate matter was measured in the landfill. Households in the landfill slum were 5.73 (p = 0.04) times more likely to be below the international poverty line (MDG 1: Poverty) and 15.6 times (p < 0.01) more likely to have no one in the household possessing a primary education (MDG 2: Universal Education), and 107 times (p < 0.01) more likely not to have improved sanitation facilities (MDG 7: Environmental Sustainability) when compared to the general population. Diarrhea is one of the leading causes of death in children under five in Indonesia. Young children living in the landfill slum were 2.87 times (p = 0.02) more likely to develop diarrhea than their general population counterparts. Other survey results and environmental measurements suggest that landfill slum children have additional adverse health effects (e.g. infections and poisoning). Poverty underlies several MDG issues that directly or indirectly affect child health. Therefore, eradicating extreme poverty will continue to be the most critical challenge for the MDGs beyond 2015.

Current state and trends of access to sanitation in Ethiopia and the need to revise indicators to monitor progress in the Post-2015 eraBMC Public Health. 2015; 15: 451.

Abebe Beyene,corresponding author Tamene Hailu, Kebede Faris, and Helmut KloosAuthor information ► Article notes ► Copyright and License information ►Go

Background - Investigating the current level and trends of access and identifying the underlying challenges to sanitation system development will be useful in determining directions developing countries are heading as they plan to promote sustainable development goals (post 2015 agenda). This research investigates the status and trends of access to improved sanitation coverage (ISC) in relation to the MDG target in Ethiopia with the aim of identifying prevailing constraints and suggesting the way forward in the post-MDG era.

Method - We examined data from a nationwide inventory conducted in accordance with the sanitation ladder at the national level and from a household survey in randomly selected urban slums in Addis Ababa. The inventory data were analyzed and interpreted using the conceptual model of the sanitation ladder. We used administrative reports and survey results to plot the time trend of the ISC.

Results - The data from the nationwide inventory of sanitation facilities, which are presented along the sanitation ladder reveal that more than half of the Ethiopian population (52.1%) still used unimproved sanitation facilities in 2014. The majority (35.6%) practiced open defecation, implying that the country is far from the MDG target for access to improved sanitation (56%). Most people in urban slums (88.6%) used unimproved sanitation facilities, indicating that the urban poor did not receive adequate sanitation services. Trend analysis shows that access to ISC has increased, but Central Statistical Authority (CSA) data reveal a decline. This discrepancy is due to differences in data collection methods and tools. Dry pit latrines are the most widely used toilet facilities in Ethiopia, accounting for about 97.5% of the ISC.

Conclusion - The sanitation coverage is far from the MDG target and the majority of the population, mainly the urban poor, are living in a polluted environment, exposed to water and sanitation-related diseases. The sanitation coverage estimates might be even lower if proper utilization, regular emptying, and fecal sludge management (FSM) of dry pit latrines were considered as indicators. In order to enhance sanitation services for all in the post-MDG era, urgent action is required that will establish proper monitoring and evaluation systems that can measure real access to ISC.

Sharing reflections on inclusive sanitation. Env & Urbanization, March 2015.

Authors: E Banana, et al.

This paper draws on sanitation innovations in  Blantyre (Malawi), Chinhoyi (Zimbabwe), Dar es Salaam (Tanzania) and Kitwe (Zambia) driven by slum(1)/shack dweller federations to consider what an inclusive approach to sanitation would involve. This includes what is possible for low-income households when there is little or no external support, no piped water supply and no city sewers to connect to.

The paper discusses low-income households’ choices in situations where households can only afford US$ 3–4 per month for sanitation (for instance between communal, shared and household provision). It also considers the routes to both spatial and social inclusion (including the role of loan finance in the four cities) and its political underpinnings. In each of the four cities, the community engagement in sanitation intended from the outset to get the engagement and support of local authorities for city-wide sanitation provision