These are some of the findings of a research study, led by SLURC in collaboration with Future Health Systems, seeking to explore relationships between living conditions in informal settlements and common health problems, and to explore whether the socioeconomic backgrounds of people living in informal settlements affect their access to health care services.
On 22 November 2018, a group of 30 community stakeholders, health professionals and policy makers came together at the Sierra Leone Urban Research Centre office in Freetown to validate the initial findings. This was an opportunity for participants from the four communities involved to discuss and validate the research findings, include any additional information that may not have been covered so far, and provide a platform for dialogue between community stakeholders and local and national government representatives around the issues raised and the ways in which these might be addressed going forwards. Following initial presentations by SLURC’s Dr Joseph Macarthy, Abu Conteh and Sudie A. Sellu, consolidating findings from focus groups and interviews, participants broke into groups to discuss and record their feedback and further ideas, before sharing these with the whole group. This was the first time all stakeholders had come together in such a way.
We have also held a similar validation exercise within the four communities of research, to get further views on what has come out the research so far. These included members of the wider community who had not yet participated in the research.
Many health issues in informal settlements are place-specific
It was clear from the initial research findings that there are many crosscutting issues affecting health across all the informal settlements included in the study, such as toilets, water, housing and energy use. Yet, within each of these issues, place is instrumental in driving the specific health conditions affecting each community. In Portee-Rokupa, residents travel huge distances to obtain water; in Cockle Bay, water is relatively available, yet some of the sources are contaminated by saltwater.
In discussion, the groups added other specific examples of the specificity of health conditions in their communities. In the hillside settlements of Dwarzark and Moyiba, accidental falls are a concern due to the terrain. Blindness is more of a concern in the seaside settlements (though causes are differentiated by gender roles - among women it is attributable to excessive smoke exposure through drying fish, while fishermen are exposed to salt water while fishing. A gender perspective has been crucial to the project – the research has found that men are more likely to use informal healthcare than women, for example. Participants shared other issues affecting all communities alike, such as strokes - believed to be prevalent due to physical strains, stress and irregular medical check-ups – and fistula - due to forced or obstructed labour caused by some inexperienced Traditional Birth Attendants.
When it comes to seeking treatment for ill health, findings from the focus groups established a range of barriers that those in Freetown’s informal settlements face when accessing healthcare, which the research team grouped into five main categories: long distances, difficult terrains, poor roads, long wait times, and the main factor - high costs. These were all corroborated by participants, and explain many of the decisions people make in how they access healthcare.
“Most men will not come to the health facilities if the health facilities are staffed by women, because of the men’s links to secret societies” (health worker)
Overcoming these barriers requires greater accountability
The full report is due for publication in December.
(Quotes are all translated from Krio)