Living in the city: Building collaborations to strengthen health systems to respond to the needs of newly urbanised populations in Africa and Asia

Many developing countries are experiencing rapid and unplanned urbanisation as people move from rural to urban areas. This can create a variety of new health risks, from non-communicable diseases (as a result of lifestyle changes) and communicable diseases (since rural-urban migrants often suffer from sub-standard housing and inadequate water and sanitation facilities). At the same time, newly- urbanised people can find it more difficult than they did in their rural lives to access health services - partly because those services are over-stretched, but also because they lack the knowledge to navigate vastly more complex urban health systems, with their plurality of public and private service providers. Through this award, we will develop the research design, methods and partnerships for a large comparative project examining these issues in four countries across South Asia and sub-Saharan Africa. The larger follow-on project will use a participatory approach to better understand lived experiences of the health costs/benefits of urbanisation and to identify mechanisms to enhance the accountability and responsiveness of urban health systems to the needs of the newly-urbanised. A pilot study in two rapidly-growing urban areas of Nepal will trial a series of participatory research methods (Participatory Video, Participatory Photo and Participatory Mapping) to capture the experiences and perceptions of both newly-urbanised people and providers of health services, focussing on: 1. How do newly urbanised people view the health risks/benefits of moving to the city? 2. How do newly urbanised people navigate pluralist urban health systems to fulfil their health needs? What health needs (if any) are they failing to fulfil? 3. What do service providers see as the particular needs and challenges facing the newly-urbanised? Through workshops with health system stakeholders and policymakers, the results of these participatory approaches will be shared and analysed, allowing us to answer: 4. How can these insights inform local, city and national health system policy and planning? Alongside the pilot study, we will undertake preparatory work for the follow-on project in Bangladesh, Ghana and Vietnam. This will involve: providing relevant training; systematically reviewing the existing literature; identifying potential research sites; building links with municipal authorities and other stakeholders and identifying their priorities; and learning lessons from the Nepal pilot that can feed into the research design of the follow-on study. The development award will lead to significant individual and institutional capacity building, through career development, the hiring of RAs, the provision of training to members of the research team, and skills and knowledge development of the participants (urban residents, health providers and decision- makers) in the pilot study.