Cities and Children: the challenge of urbanisation in Tanzania

Cities are becoming home to a growing proportion of Africa’s children. In Tanzania, already one in four lives in an urban centre – and\ud many more will in coming years. Within the short span of a generation, more than one-third of Tanzania’s children will be raised in a city\ud or town. Growing up urban can offer these children the chance for a brighter future, or the grim conditions in which so many are now\ud living in the sprawling cities of the continent.\ud \ud Increasingly urban\ud Tanzania is more urbanised than it perceives itself to be. Urban Tanzanians feel emotionally rooted in their villages of origin, rather than\ud in the cities and towns where they live. Despite this perception, conditions that are typical of urban areas are more widespread across\ud Tanzania than official figures disclose. Extensive, heavily populated areas are often counted as ‘rural’ simply because they are not\ud officially classified as ‘urban’. Nestled in one of the world’s fastest urbanising region, Tanzania itself is urbanising fast. Nearly half of its\ud urban population is already, and will continue to be, made up of children younger than 18 years.\ud As urbanisation rapidly transforms Tanzania’s physical, social and economic landscape, attention must be paid to the conditions in\ud which new generations of Tanzanian children will be raised. Far too many are living in overcrowded informal settlements that lack\ud clean water and adequate sanitation. They play in heaps of garbage littered with dangerous and even toxic materials. Their families\ud cannot afford quality food, schools or health care; their health and well-being are constantly at risk from mosquitos and other pests that\ud thrive in unsanitary environments – as well as human predators that prey on those least able to defend themselves, exposing children\ud to violence, abuse and sexual assault that increase their risk of HIV infection. Tanzania’s urban children today are more often exposed\ud to the ugly underbelly of city life than to its potential advantages. Fulfilling the rights and aspirations of these children will be a major\ud challenge; careful and timely preparation is needed to address it adequately.\ud \ud Urban advantage\ud The challenges posed by urban growth continue to receive scant attention from policy makers, due partly to widespread belief in\ud an ‘urban advantage’ – the idea that compared to rural residents, city dwellers are invariably better off. It is true that cities enjoy an\ud edge: high concentration of people, proximity and economies of scale permit cities to become engines of growth. Facilities, services,\ud infrastructure and amenities are more readily available in urban than rural settings. Urban centres offer more avenues for jobs and\ud education, and can provide children with greater opportunities for survival, growth and development. Economic resources and political\ud visibility enhance the scope for investments in critical services and infrastructure that can make service provision less costly and more\ud widely available than in Tanzania’s vast and sparsely populated hinterland. Urban areas are also hubs of technological innovation and\ud social interaction. It is no wonder that children and young people are often attracted to cities, where they can draw from resources that\ud are denied to their rural peers.\ud \ud City promises… and realities\ud But for many urban children, the notion of an unqualified ‘urban advantage’ simply does not hold true. Life in the sprawling, unplanned\ud informal settlements of most Tanzanian cities does not match the promise that urban life is supposed to fulfil. The misconception\ud according to which urban dwellers must invariably be better off than rural people stems partly from the tendency to equate availability\ud of services with access to them. But in most cities adequate facilities and quality services are distributed unequally across the urban\ud space, concentrated in affluent areas that tend to attract the most qualified teachers, health workers and other service providers.\ud Meanwhile, the less well-endowed schools and health facilities are located in the poorer parts of a city – the unplanned settlements\ud where up to 80 per cent of urban residents live, most of whom cannot afford to pay fees and other costs for services. The truth is that\ud the ‘urban advantage’ is not shared by all city dwellers.\ud Only a limited few can afford services and amenities that would be unthinkable in a rural setting; the majority not only experience levels\ud of deprivation not unlike those affecting rural children, but a host of social, physical and environmental ills that are specific to an urban\ud context – contaminated water and polluted air, traffic congestion and noise, cramped living conditions in substandard shelters built\ud along riverbanks, on steep slopes or dumping grounds, untreated waste washing away into waterways, lack of safe places for children\ud to gather and play, among other troubling signs of urban malaise.\ud \ud Narrowing gaps\ud Official statistics that compare overall conditions in rural and urban areas tend to mask the actual living conditions of poor urban\ud dwellers. Even so, they indicate that the vaunted urban edge is eroding with the passage of time. For many dimensions of child wellbeing,\ud Tanzania’s rural areas are catching up with cities, where the provision of social services and infrastructure has not kept pace\ud with the growing demand generated by rapid urban growth. For instance: Availability of basic services, expected to be higher in urban centres than remote rural areas, has been declining. Consequently, thetraditional performance gap across the rural/urban divide has narrowed for many indicators in education, health, nutrition, water and sanitation. In some cases rural areas now outperform urban centres.\ud As urban performance stagnates and even declines, it is likely that poor, under-serviced communities are being hit hardest. Although\ud aggregate figures for urban and rural areas prevent detailed analysis of intra-urban disparities, evidence from low-income urban\ud communities – on access to basic services and on health and education outcomes – suggests that poor urban children may often\ud be faring worse than rural peers.\ud \ud Hidden poverty\ud Despite these trends, national policy and programme frameworks continue to mostly target rural poverty, perceived as the nation’s core\ud development challenge. Urban poverty, growing alongside urban affluence, remains mainly unnoticed and, therefore, unaddressed.\ud By depicting rural and urban averages that obscure the disparities so prevalent in cities and towns, official statistics largely miss out\ud on the conditions of the urban poor and their children. Moreover, standard measures of poverty typically underestimate its true extent\ud in urban settings, where families have to incur high costs to afford not only food, but also housing, schooling, health, transport and\ud other necessities. In a monetised urban economy, all necessities have to be purchased with cash, a rare commodity when jobs are\ud irregular and poorly paid. Hidden in official estimates and tucked away in peripheral urban fringes, poor children thus run the risk of\ud remaining invisible in development policy and investments. Gathering and analysing sub-municipal data must be a priority for planners,\ud service providers and communities; local-area data can help to reveal the actual conditions in which poor children live, as well as the\ud inequalities that exist side by side within the confines of a city.\ud \ud An urban future\ud Urban growth is projected to continue in coming decades, and could even accelerate. If the current predicament facing Tanzania’s\ud urban centres is not addressed now, conditions will likely deteriorate. As density increases and unplanned settlements become more\ud congested, investments in facilities, services and infrastructure are likely to become costlier, both financially and socially. Unless it is\ud leveraged properly, the potential advantage that cities can offer could turn instead into a disadvantage. Already Dar es Salaam has one\ud of the highest proportions of urban residents living in unplanned settlements in all of sub-Saharan Africa. If present trends continue\ud unabated, Tanzania could then find itself facing a daunting scenario: not only are today’s urban children exposed to one of the most\ud hazardous environments imaginable, but climate change is poised to further increase their vulnerability. Clearly the future need not\ud pose a threat. It is ultimately up to the current generation of Tanzanians to ensure that their children will get the best, while avoiding the\ud worst that cities have to offer.\ud \ud Urban governance\ud Urban centres must seek ways to exploit their edge – or watch it disappear. The difference will lie in how access to resources is\ud managed in Tanzania’s towns and cities. A competent, accountable and equitable system of local governance can make that difference.\ud Good local governance can help overcome the disparities that bar access by the urban poor to resources, services and infrastructure:\ud secure land tenure and decent housing, safe water and sanitation, quality education, adequate health care and nutrition, affordable\ud transport. Good local governance can make the difference between a city friendly to children and one that is indifferent to their needs\ud and rights. Municipal governments have the advantage of being close to their constituents; they could make the most of this situation\ud by forming alliances with civil society groups, the media, private sector, community organisations and others, with the aim of improving\ud the conditions in which poor urban families live. Accountable local authorities, proactive communities and children are key actors in a\ud governance process seeking to create an urban environment fit for children.\ud \ud Citizenship and participation\ud Children and adolescents have a right to express their opinions in both defining their problems and providing solutions. This is a right\ud enshrined in the Convention on the Rights of the Child. Today, Tanzania’s children and adolescents already take part in local governance\ud processes. Some are active in Children’s Municipal Councils, School Barazas and other grassroots institutions. But the majority are\ud rarely consulted – at home, at school or in their communities. Listening to children’s voices can inform local decision-makers about the\ud world in which they live and how they see it, thereby offering a more nuanced understanding of “childhood” and how specific social,\ud cultural and economic realities condition children’s lives. Their scale and proximity makes cities and communities the most relevant\ud place for genuine participation by children.\ud \ud Child-friendly cities\ud It is ultimately in Tanzania’s local communities that children’s rights will be realised and global development goals will be met – in the\ud family, the school, the ward, and the city. Cities offer an ideal platform for convergence of development interventions that normally\ud target children independently, in a fragmented manner. Instead, they need to be delivered holistically, which is easier at the level where\ud children live. Children’s horizon is local. If development goals and children’s rights are not implemented locally, they are likely to remain\ud abstract declarations of intent, without practical translation.\ud Creating an environment friendly to children in every town and city of Tanzania is not only a laudable goal, but a sensible choice for\ud municipal authorities around the country. Local authorities, communities, families and children can and must work together to transform\ud today’s often hostile urban settings into child-friendly cities – as cities friendly to children are ones that are friendly to all.\u

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Distributional impacts of cash allowances for children: A microsimulation analysis for Russia and Europe

This article analyses programmes of cash allowances for children and compares their effectiveness in combating child poverty in Russia and four European Union (EU) countries representing alternative family policy models – Sweden, Germany, Belgium and the United Kingdom. Using microsimulation models, this article estimates the potential gains if the Russian system were re-designed along the policy parameters of these countries and vice versa. The results confirm that the poverty impact of the programme design is smaller than that of the level of spending. Other conditions being equal, the best distributional outcomes for children are achieved by applying the mix of universal and means-tested child benefits, such as those employed by the United Kingdom and Belgium. At the same time, the Russian design of child allowances does not appear to be less effective in terms of its impact on child poverty when transferred to European countries in place of their current arrangements

Impact of a Citywide Sanitation Program in Northeast Brazil on Intestinal Parasites Infection in Young Children

BACKGROUND: Sanitation affects health, especially that of young children. Residents of Salvador, in Northeast Brazil, have had a high prevalence of intestinal parasites. A citywide sanitation intervention started in 1996 aimed to raise the level of sewer coverage from 26% to 80% of households. OBJECTIVES: We evaluated the impact of this intervention on the prevalence of Ascaris lumbricoides, Trichuris trichuria, and Giardia duodenalis infections in preschool children. METHODS: The evaluation was composed of two cross-sectional studies (1998 and 2003-2004), each of a sample of 681 and 976 children 1-4 years of age, respectively. Children were sampled from 24 sentinel areas chosen to represent the range of environmental conditions in the study site. Data were collected using an individual/household questionnaire, and an environmental survey was conducted in each area before and after the intervention to assess basic household and neighborhood sanitation conditions. Stool samples were examined for the presence of intestinal parasites. The effect of the intervention was estimated by hierarchical modeling, fitting a sequence of multivariate regression models. FINDINGS: The prevalence ofA. lumbricoides infection was reduced from 24.4% to 12.0%, T. trichuria from 18.0% to 5.0%, and G. duodenalis from 14.1% to 5.3%. Most of this reduction appeared to be explained by the increased coverage in each neighborhood by the sewage system constructed during the intervention. The key explanatory variable was thus an ecological measure of exposure and not household-based, suggesting that the parasite transmission prevented by the program was mainly in the public (vs. the domestic) domain. CONCLUSION: This study, using advanced statistical modeling to control for individual and ecological potential confounders, demonstrates the impact on intestinal parasites of sanitation improvements implemented at the scale of a large population

Toilet training: what can the cookstove sector learn from improved sanitation promotion?

Within the domain of public health, commonalities exist between the sanitation and cookstove sectors. Despite these commonalities and the grounds established for cross-learning between both sectors, however, there has not been much evidence of knowledge exchange across them to date. Our paper frames this as a missed opportunity for the cookstove sector, given the capacity for user-centred innovation and multi-scale approaches demonstrated in the sanitation sector. The paper highlights points of convergence and divergence in the approaches used in both sectors, with particular focus on behaviour change approaches that go beyond the level of the individual. The analysis highlights the importance of the enabling environment, community-focused approaches and locally-specific contextual factors in promoting behavioural change in the sanitation sector. Our paper makes a case for the application of such approaches to cookstove interventions, especially in light of their ability to drive sustained change by matching demand-side motivations with supply-side opportunities

Identifying an essential package for school-age child health: economic analysis

This chapter presents the investment case for providing an integrated package of essential health services for children attending primary schools in low- and middle- income countries (LMICs). In doing so, it builds on chapter 20 in this volume (Bundy, Schultz, and others 2017), which presents a range of relevant health services for the school- age population and the economic rationale for adminis- tering them through educational systems. This chapter identifies a package of essential health services that low- and middle-income countries (LMICs) can aspire to implement through the primary and secondary school platforms. In addition, the chapter considers the design of such programs, including targeting strategies. Upper- middle-income countries and high-income countries (HICs) typically aim to implement such interventions on a larger scale and to include and promote additional health services relevant to their populations. Studies have docu- mented the contribution of school health interventions to a range of child health and educational outcomes, partic- ularly in the United States (Durlak and others 2011; Murray and others 2007; Shackleton and others 2016). Health services selected for the essential package are those that have demonstrated benefits and relevance for children in LMICs. The estimated costs of implementation are drawn from the academic literature. The concept of a package of essential school health interventions and its justification through a cost-benefit perspective was pioneered by Jamison and Leslie (1990). As chapter 20 notes, health services for school-age children can promote educational outcomes, including access, attendance, and academic achievement, by mitigat- ing earlier nutrition and health deprivations and by addressing current infections and nutritional deficiencies (Bundy, Schultz, and others 2017). This age group is partic- ularly at risk for parasitic helminth infections (Jukes, Drake, and Bundy 2008), and malaria has become prevalent in school-age populations as control for younger children delays the acquisition of immunity from early childhood to school age (Brooker and others 2017). Furthermore, school health services are commonly viewed as a means for build- ing and reinforcing healthy habits to lower the risk of non- communicable disease later in life (Bundy 2011). This chapter focuses on packages and programs to reach school-age children, while the previous chapter, chapter 24 (Horton and Black 2017), focuses on early childhood inter- ventions, and the next chapter, chapter 26 (Horton and others 2017), focuses on adolescent interventions. These packages are all part of the same continuum of care from age 5 years to early adulthood, as discussed in chapter 1 (Bundy, de Silva, and others 2017). A particular emphasis of the economic rationale for targeting school-age children is to promote their health and education while they are in the process of learning; many of the interventions that are part of the package have been shown to yield substantial benefits in educational outcomes (Bundy 2011; Jukes, Drake, and Bundy 2008). They might be viewed as health interventions that leverage the investment in education. Schools are an effective platform through which to deliver the essential package of health and nutrition ser- vices (Bundy, Schultz, and others 2017). Primary enroll- ment and attendance rates increased substantially during the Millennium Development Goals era, making schools a delivery platform with the potential to reach large num- bers of children equitably. Furthermore, unlike health centers, almost every community has a primary school, and teachers can be trained to deliver simple health inter- ventions, resulting in the potential for high returns for relatively low costs by using the existing infrastructure. This chapter identifies a core set of interventions for children ages 5–14 years that can be delivered effectively through schools. It then simulates the returns to health and education and benchmarks them against the costs of the intervention, drawing on published estimates. The invest- ment returns illustrate the scale of returns provided by school-based health interventions, highlighting the value of integrated health services and the parameters driving costs, benefits, and value for money (the ratio of benefits to costs). Countries seeking to introduce such a package need to undertake context-specific analyses of critical needs to ensure that the package responds to the specific local needs