Urban Health and Poverty Research: Local Knowledge, Local Solutions

Much of human progress in due to specialization, which in turn was realized when people started living in cities. Even Aristotle thought that city living was a necessary condition fo "Eudaimonia" or a good life. Recent years have seen rapid urbanization world-wide. Today around 82% of North Americans, 40-48% of Asians and around 55% of Pakistanis live in cities. 

Cities allow people to come together, to work with, share, build on and trade with each other. This allows specialisation and wealth creation that have driven the prosperity of the past 200 years. 

But with all this good come some problems. Urban poor live in some of the densest human settlements ever in human history. There are parts of Dhaka in Bangladesh that have over 1 million people per square kilometre. The same "agglomeration" or clustering of people, that drives innovation and prosperity also bring very large of poor peple to live in crowded settlements - at least initially when they move to cities - where there are too many poor people together living in squalid conditions and with few opportunities. 

Akhtar Hameed Khan Resource Centre (AHKRC) is implementing its’ first community-based development model through a bottom-up approach with Research and Development Solutions (RADS) as its’ research partner. The aim is to study urban development, create a platform to connect diverse actors, and provide innovative solutions according to the community’s primary needs. 

We are working in Dhok Hassu/ Zia Colony in Rawalpindi, Pakistan. Dhok Hassu is a small colony with approximately 195,000 people (density around 142,000/sqkm) that is in the heart of the old city. It is one of the 17 such settlements in the Rawalpindi-Islamabad area with an estimated combined population of around 1.5-2 million.

95% of its workers have non-specialised jobs, even when around 20% of these have a Masters degree or more. There is 25% unemployment among men and 75% among women. Healthcare is provided by 122 private and 3 government providers (some slightly outside the boundaries of DH) and education by 116 private and one government school.
CPR is 35%, mostly with condoms.

Around half of the deliveries are at home

Most streets are paved but have open drains. Two thirds of homes have toilets that are connected to these drains (a third either dont have a toilet or have one not connected to the drains) that are managed to some extent (at a larger street but not smaller lane level) managed by the city municipality.

Our model builds on our work to develop functional networks with local CBOs, local politicians and government officials, along with local universities. We work with the community to identify demand for services and products and either work to provide these or leverage the resources of our partners to do so. The concept comprises of the development of an “on ground” infrastructure to conduct research and interventions that mitigate poverty or improve the identified indicators in Dhok Hassu. We believe we can contribute to developing an ecosystem of research and interventions that focus on urban poverty and help develop an evidence base of lessons about what works in poor urban settings.

The next immediate step is to use a community driven approach to develop  outreach, create demand, and sell maternal and child health and family planning supplies to local residents. The results of the intervention will be rigorously tested and if found to be successful, will be scaled up locally in other similar localities in Islamabad-Rawalpindi are and beyond. An outline of these ideas and some of the data mentioned is available.

Dhok Hassu Health Camp

Under its Urban Poverty initiative Akhter Hameed Khan Resource Center (AHKRC) organized 2nd quarterly Health Camp on Saturday, 3rd September, 2016, in UC-5 Dhok Hassu Rawalpindi – with the coordination of Research and Development Solutions (RADS). The health camp brought together the resources and expertise of public and private organizations working in health sector specifically for maternal and child health. They included Population Welfare Department, Rahnuma- FPAP, Sightsavers International and Rotary International - Rawalpindi chapter. Chairman UC 5 - Dr. Shafqat Hussain, facilitated in arranging for the venue by opening his residence to set up stalls/stations for the teams of doctors from participating organizations. There were three main Service stalls at the Health Camp. General health issues were catered by the team of doctors from Rahnuma – Family Planning Association of Pakistan (FPAP), who were later joined by the volunteer nursing graduates from Shifa Medical College. Almost 700 people participated in the health camp. Amongst these were 560 registered participants including 270 children and 290 females. However, only a few men participated in the health camp, almost all of them elderly. Free contraceptive implants and IUCD insertions were available to the relevant patients. Thirteen women availed the facility of implants. Patients were given free medicine, some patients needing advance care were also referred to the FPAP clinic in Dhok Hassu.