This blog was written by Dr Basirat Oyalowo who lectures at the Department of Estate Management and Valuation, University of Lagos, Nigeria. Dr Oyalowo recently ran a five-day workshop, funded by SHLC’s Capacity Development Acceleration Fund, to increase ability to conduct urban research at the neighbourhood level.
In most parts of Africa, households in slum communities tend to be the most vulnerable to infectious diseases and their homes epitomise the microcosm of problems associated with overcrowding, shared toilet and washing facilities, and lack of access to a clean and safe water supply.
Progress towards improving housing for the 881 million that the UN-habitat estimates live in slums and increasing access to safe and clean water, sanitation and hygiene facilities has already been very slow. In 2017, the World Health Organization estimated that globally, 844 million people are without access to safe and clean drinking water, 4.5 billion people do not have toilets at home, while 600 million people share a toilet or latrine with other households and only 14% of people in Sub-Saharan Africa have handwashing facilities with soap and water at home.
And then… COVID-19 hit! Already vulnerable, households in slum communities are now faced with social distancing and isolation in circumstances where this is near impossible.
Public health to the rescue? Not in the homes of slum communities
Research findings based on recommendations from The World Health Organization tells us that promoting Non-Pharmaceutical Interventions (NPI) is the key element to managing and fighting pandemics such as COVID-19. This approach relies on robust public health measures, which focus on slowing and stopping transmission, preventing outbreaks and delaying spread, providing optimised care for all patients as well minimising the impact of the epidemic on health systems, social services and economic activity.
Interestingly, but inevitably in pandemic situations, these kinds of public health measures happen at home, as the home plays a critical role in preventing and containing the spread of infectious diseases. For example:
- Staying safe at home to reduce the risk of infection.
- Self-isolating at home to contain spread by contacts of confirmed cases and asymptomatic people.
- Managing confirmed mild cases of COVID-19 at home as a strategy to reduce pressure on hospitals.
- Managing affected family members who no longer need to be in the hospital in a well-ventilated single room not shared by any other person.
But, if you live in multi-family housing, where a family of up to seven live in a ‘room and parlour’, sharing the building with over 10 other families in some instances, how on earth do you practice these measures?
Families queue up to share outdoor bathrooms and toilets that are often left without a constant water supply so people have to fetch water from free public water taps down the street or purchase water from a neighbour’s tap nearby.
This inevitably creates conflicts over the amount of water fetched and often disputes are settled in the endless queues for water. If not properly protected, buckets of water can be ‘misplaced’ so strict rationing is essential. In Lagos, we call multi-family houses ‘face-me-I-face-you’ because they usually have two rows of (sometimes more than) five rooms separated by a corridor. Or more colloquially, ‘face-me-I-slap-you’, because of the tensions that arise from so many families sharing basic amenities.
"... if you live in multi-family housing, where a family of up to seven live in a ‘room and parlour’, sharing the building with over 10 other families in some instances, how on earth do you practice these social distancing and isolating measures?"
A way forward? Pro-active investment, not re-active problem solving
Before COVID-19, overcrowding during the daytime was usually masked. Residents often leave their homes relatively early to go to work as low-income salaried workers, entrepreneurs and artisans of all callings, returning late at night to socialise and sleep. School children return home and look after themselves or are cared for by housewives, next-room neighbours, and mothers who work from home or have shops nearby. But the COVID-19 pandemic has brought everyone back home, together, sharing common facilities for days and weeks on end.
It is at this point that the high risk of community spread due to prolonged, reactionary, enforced stay at home public health measures begins to rear its ugly head.
Preventing community spread between neighbours, and when visiting communal utility access points, like outdoor water taps, becomes very tricky. The fear of community spread implies an appreciation of risk factors, such as the inability to practice physical and social distancing. But how are communities supposed to avoid these risks when there has been limited government expenditure to improve access to basic facilities and improve adequate housing standards? This is especially important given that infectious disease experts also tell us that public health measures and non-pharmaceutical interventions are best applied proactively rather than reactively if they are to reduce the spread of transmission and illness.
Do the dire circumstances of COVID-19 we are witnessing today now draw attention and prompt intervention to support better housing and WASH facilities in these neighbourhoods? Will governments now see the need for preventive actions like improving access to indoor water supply, supporting housing upgrades and improving sanitary conditions in individual homes? And will they see these actions as investments in community health and livelihoods rather than social burdens? Will governments now realise the importance of housing as a social good that need not be completely liberalised? And that the provision of basic facilities are integral public goods that must drive development? Only then will these communities become more resilient to infectious diseases such as COVID-19.
"Preventing community spread between neighbours, and when visiting communal utility access points, like outdoor water taps, becomes very tricky. The fear of community spread implies an appreciation of risk factors, such as the inability to practice physical and social distancing. But how are communities supposed to avoid these risks when there has been limited government expenditure to improve access to basic facilities and improve adequate housing standards?"
Time to integrate housing and WASH
The WHO tells us that public health measures are and will continue to be an important tool to reduce the transmission and spread of COVID-19. And I agree. And this is why I am calling for housing and accessible water, sanitation and hygiene (WASH) facilities to be tackled together. WASH deficiencies cluster in the home and amplify vulnerability to infections. The COVID-19 pandemic has now exacerbated this problem.
If strategic actions to integrate and improve housing and WASH standards are not taken, then it appears residents of multi-tenanted housing will continue to rely on their own social organisation and resilience to protect themselves and the virus will spread like wildfire. And it will be up to governments to contend with the social, economic and political consequences of their inactions.
This is such an informative, timely and thoughts provoking read. Hopefully, this reaches far and wide, and most importantly, those in the hem of affairs; so that the valid recommendations here can be implemented and fast. Well done, Dr. Oyalowo! This is absolute ma.
The covid-19 pandemic has once again exposed the gigantic flaws in the social welfare and social security of the common Nigerian citizen.. Indeed it is a hard reality that social distancing which is required to stem the spread of corona virus is difficult to observe in overcrowded communities. I reside on the outskirts of Lagos and Ogun States and I witnessed a scene on my way to a nearby ATM; that baffled me. Thousands of people gathered in hot sunshine on both sides of a major road despite the social distancing order. I inquired and was told the cluster was due to food sharing by a Non Governmental Organisation NGO) No one should blame these people for thronging together because food is a basic necessity for life.
The Nigerian Government should as matter of urgency create a social welfare system akin to the ones obtainable in developed countries to aid citizens in emergency situations like this.
Good peace, well articulated. Having gone through your submission, my position is the gamut of problems associated with communal and social well.being of those at the bottom of the pyramid must be holistic.
Tackling these problems must encompass, tackling corruption, build leadership capacity, build economy that work for all social status, design and build a functional and sustainable houses, engage in massive urban renewal and so on. Its heartbreaking when you have leaders that are semi illiterates, selfish and have huge appetites for illicit wealth acquisition.
Rome they say was not built in a day, evolving a sustainable housing will solve huge challenges faced by the nation; but the fact is do these leaders understand that housing is life?, productivity, security, good health, politics, business and many more are all tied to good housing.
Nigeria must be run as a knowledge base economy otherwise, nobody is immune against uproar . Leaders must put on their thinking cap to liberare the most populous nation from collapse. Goverment must be proactive as against reactive, Covid 19 esposed the nation massively. Massive investment is required in education, health,industrialisation,infrastructures leadership capacity and so on.
And on the final note, individual will help government at our level if we chose to change our ways of doing things.
This is a thought provoking piece. Indeed, a strong connection exists between housing and public health therefore interventions ought to be all encompassing.
The effectiveness of public health measures is largely defined from home, hence the need to ensure that the home is indeed habitable for dwellers. All stakeholders ought to play their role now and in the future!