Bringing better water and sanitation to informal settlements

Degraded conditions in informal settlements damage people’s health. But repairing and regenerating water and sanitation offers more than health benefits – it can also increase climate resilience, gender equality and prosperity. Rebekah Brown reports

More than one billion people live in informal settlements around the world today. Residents typically set up home on marginal, flood-prone or unstable land outside normal urban-planning schemes. Living conditions here are challenging.

Informal settlements have poor, if any, access to safe water and sanitation. This makes people more vulnerable to infectious and non-communicable disease, undernutrition and malnutrition. Overcrowded people living in poverty can suffer from poor mental health, exposure to violence and often have limited access to healthcare and education.

But urban informal settlement populations are also on the frontlines of climate-change impacts, being disproportionately impacted by flooding, sea level rise and extreme weather events.

The challenge is complex and, so far, intractable – despite significant investment in water, sanitation and hygiene (WASH) programmes and in major infrastructure.

At the current rate of urbanisation, the number of people living in urban informal settlements is expected to triple to three billion by 2050. This will far outpace the ability of governments and aid agencies to meet the need of the poor and vulnerable residents.

Tackling such a complex challenge demands a new, systems-based approach to transform people’s conditions. Residents’ physical, emotional and financial health and the health of their living conditions are interdependent and inseparable. They are linked to many other dimensions including climate resilience, gender equality and social inclusion.

But the first step in developing a new approach is to obtain rigorous evidence of implementability, impact and economic viability – to unlock the political will to invest in these novel solutions.

That vision gave birth to the Revitalising Informal Settlements and their Environments (RISE) programme. It aims to improve human, environmental and ecological health in urban informal settlements across the developing world. And it creates a new approach to delivering urban water and sanitation services, and delivering robust research to prove its impact and value.

Water-sensitive approach

A water-sensitive approach deals with the entire water cycle in a holistic, multi-dimensional way. This approach has been delivering sustainable, cost-effective health and environmental improvements in many developed countries for decades. But the RISE programme was the first to apply this approach to urban informal settlements in low- and middle-income countries.

RISE’s water-sensitive approach harnesses decentralised, nature-based, community-scale systems to treat wastewater, for drainage and flood management, improved access and other measures to reduce habitual exposure to disease-causing pathogens, improve the quality of the local and downstream environments, and generally improve living conditions and access to basic water and sanitation services.

Informal settlements are dynamic social and physical environments. Water-sensitive revitalisation requires new institutional, technical and human capacity to design, plan, implement, and monitor programmes and projects. It features technical components and infrastructure that are new for many cities.

That makes it necessary to codesign upgrades based on an intensive participatory process with communities. And it involves these communities in long-term custodianship and maintenance of installed components.

Integrating research

RISE is an impact research programme. It combines implementing a codesigned, water-sensitive community upgrade in informal settlements in Indonesia and Fiji with a randomised control trial (RCT) research framework that sets a gold standard.

The RCT involves 24 informal settlements in Suva, Fiji and Makassar, Indonesia. Researchers divided them, randomly, into 12 intervention groups and 12 control groups.

The intervention group will receive water-sensitive upgrades first. After construction, the researchers will compare the intervention group’s human and environmental health with that of the control settlements, which will be upgraded once sufficient scientific monitoring is in place.

The programme takes a multi-disciplinary, planetary health’ approach. It assesses people’s health using surveys and biometric sampling of children. It also tracks ecological changes and environmental contamination, with genomic analyses of human faecal samples and environmental samples for pathogens and disease.

It monitors community wellbeing, water quality and infrastructure system performance and gathers the socioeconomic evidence that policymakers will find most compelling to scale up the approach.

This is the first intervention to gather such rigorous scientific evidence – something critical to address urban challenges with new solutions.

Armed with this evidence, we can start to shift the way we talk about informal settlements – moving away from patching up problems to find new ways to invest in sustainable solutions to unleash people’s potential – today and for future generations.

Lessons learned

Although we expected this to be the case, we cannot overstate how critical it was for the programme to build deep partnerships and stakeholder engagement and participation across different groups, at all levels.

That work includes central and local government, communities, service providers and civil-society groups. These political partnerships are desirable but they are also, ultimately, enabling: new approaches require buy-in, internal advocacy and a change in perspective and procedures.

It also takes well-trained local practitioners from diverse backgrounds who can navigate nuances and safeguard the longevity of new solutions. It is vital to look to local teams, who offer early engagement with communities and expert understanding of each informal settlement’s specific social dynamics.

It would be impossible to deliver RISE without strong, locally led teams. Acknowledging this expert knowledge is not enough. What matters is genuine capacity building. When Covid-19 brought significant challenges for RISE, the local teams in Fiji and Indonesia kept the programme advancing. Thanks to them, RISE emerged stronger from the pandemic.

Developing RISE has shown how crucial it is to involve communities in upgrading informal settlements – not as a one-off event and not as a box to tick. Community involvement is critical and integral to upgrades’ sustainability and practical utility. It’s how you ensure that no one gets left behind.

The RISE co-design process involves the entire community; men, women, youth and children. It brings people together multiple times over several weeks to learn about healthy environments and understand how members of the community in question use space. People work together to map out their needs and possible areas for infrastructure.

As one resident of a pilot upgrade in Makassar pointed out: “Now, we don’t fear as much when the rain comes. [Before RISE] it was a life struggle because water wouldn’t flow out [of our settlement] smoothly, but now it does go out right away.”

That’s the kind of experience that highlights the immediate benefits of sanitation and improvement of the biophysical environment – as well as important, positive impacts on the mental health of residents who previously endured such harsh living conditions that they were frightened when it rains.

A lasting legacy

RISE is now entering an exciting phase. It has gathered two years’ worth of baseline data from the informal settlement communities in Fiji and Indonesia. The data builds up a picture of the current health status of people and their environments.

Researchers have started to upgrade the intervention communities, turning paper designs into reality in ways that change the residents’ lives forever.

But RISE is also establishing laboratories and research capacity with local university partners in Fiji and Indonesia. It is training a cohort of local lab technicians and field practitioners, introducing state-of-the-art, genomics-based pathogen analysis and uplifting research capacity.

This will be RISE’s lasting legacy. Beyond building facilities and skills, it has built up research that supports the premise that, given the chance, it is people on the ground that are best placed to lead new initiatives beyond RISE.

We envisage a better quality of life for billions of people, regardless of their circumstance, starting from this trial.

We believe a bolder, better new approach to water and sanitation servicing is possible. We would also argue that it is essential, to deliver our fundamental, moral obligation to improve the status quo for everyone.

Find out more:

Rebekah Brown is Monash University’s deputy vice-chancellor, research and senior vice-president and director of the RISE programme

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