The health and sanitation status of specific low-cost housing communities as contrasted with those occupying backyard dwellings in the city of Cape Town, South Africa

Govender, Thashlin (2011-12)

Thesis (PhD)--Stellenbosch University, 2011.

Thesis

ENGLISH ABSTRACT: South Africa embarked on an ambitious program to rehouse the informally housed poor. These initiatives were formerly called the RDP and later the BNG programmes. This was aimed at improving the living conditions of the urban poor and consequently their health and poverty status. These low-cost houses were quickly augmented by backyard shacks in almost all settlements. The present study is an epidemiological assessment of the health and sanitation status of inhabitants of specific low cost housing communities in the City of Cape Town as contrasted with those occupying ‘backyard dwellings’ on the same premises. The study was undertaken in four low-cost housing communities identified within the City. A health and housing evaluation, together with dwelling inspections were carried out in 336 randomly selected dwellings accommodating 1080 inhabitants from Tafelsig, Masipumelela, Driftsands and Greenfields. In addition, the microbiological pollution of surface run-off water encountered in these settlements was assessed by means of Escherichia coli levels (as found by ColilertTM Defined Substrate Technology) as an indication of environmental health hazards. The study population was classified as ‘young’ - 43% of the study population was aged 20 years or younger. Almost a third of households were headed by a single-parent female. In all four communities combined, 47.3% of households received one or other form of social grant. At the time of inspection 58% of the toilets on the premises were non-operational, while all the houses showed major structural damage - 99% of homeowners reported not being able to afford repairs to their homes. In 32% of dwellings one or more cases of diarrhoea were reported during the two weeks preceding the survey. Five percent of the participants willingly disclosed that they were HIV positive, while 11% reported being TB positive (one of them Multiple Drug Resistant TB). None of the HIV positive or TB positive persons was on any treatment. The E. coli levels of the water on the premises or sidewalks varied from 750 to 1 580 000 000 organisms per 100 ml of water - thus confirming gross faecal pollution of the environment. Improvements in health intended by the re-housing process did not materialise for the recipients of low-cost housing in this study. The health vulnerability of individuals in these communities has considerable implications for the health services. Sanitation failures, infectious disease pressure and environmental pollution in these communities represent a serious public health risk. The densification caused by backyard shacks also has municipal service implications and needs to be better managed. Policies on low-cost housing for the poor need realignment to cope with the realities of backyard densification so that state-funded housing schemes can deliver the improved health that was envisaged at its inception. This is in fact a national problem affecting almost all of the state funded housing communities in South Africa. Public health and urban planning need to bridge the divide between these two disciplines in order to improve the health inequalities facing the urban poor.

AFRIKAANSE OPSOMMING: Suid-Afrika is besig met 'n ambisieuse program om diegene wat in informele behuising woon te hervestig. Hierdie inisiatiewe is voorheen die HOP en tans die “BNG” programme genoem. Hierdie hervestigingsprogramme is gemik daarop om die lewensomstandighede van die stedelike armes en dus hulle gesondheid- en armoedestatus te verbeter. Hierdie laekoste huise is algou in byna alle nedersettings aangevul deur krotwonings in die agterplase. Die huidige studie is 'n epidemiologiese beoordeling van die gesondheid en sanitasiestatus van inwoners van spesifieke laekoste behuisingsgemeenskappe in die Stad Kaapstad in vergelyking met diegene wat krotwonings op dieselfde erwe bewoon. Die studie is onderneem in vier laekoste-behuising gemeenskappe geselekteer in die stadsgebied. 'n Gesondheid- en behuisingevaluasie tesame met 'n inspeksie van elke woning is uitgevoer in 336 ewekansig geselekteerde wonings wat 1080 inwoners gehuisves het. Die woonbuurte was Tafelsig, Masipumelela, Driftsands en Greenfields. Mikrobiologiese besoedelingsvlakke van oppervlak-afloopwater in hierdie gemeenskappe is bepaal deur middel van die bepaling van Escherichia coli vlakke (met behulp van ColilertTM Gedefinieerde Substraat Tegnologie) as aanduiding van gesondheidsgevare in die omgewing. Die studiepopulasie is as ‘jonk’ geklassifiseer - 43% was 20 jaar of jonger. Amper een-derde van die huishoudings het 'n enkelouer-vrou aan die hoof gehad. In al vier gemeenskappe gesamentlik het 47.3% van die huishoudings die een of ander vorm van maatskaplike toelae ontvang. Tydens inspeksie is 58% van die toilette op die erwe as "nie-funksioneel" bevind, terwyl al die huise substansiële strukturele skade getoon het - 99% van die huiseienaars het gerapporteer dat hulle nie herstelwerk aan hulle huise kan bekostig nie. In 32% van die wonings is daar een of meer gevalle van diarree gedurende die voorafgaande twee weke voor die opname gerapporteer. Vyf persent van die deelnemers het vrywillig gerapporteer dat hulle HIV positief was terwyl 11% gerapporteer het dat hulle TB positief was (een was Veelvuldige Middelweerstandige TB). Nie een van die HIV positiewe of TB positiewe persone was op enige behandeling nie. Die E. coli vlakke van die water op die erwe of sypaadjies het gewissel vanaf 750 to 1 580 000 000 organismes per 100 ml water - wat erge fekale besoedeling van die omgewing bevestig het. Die verbetering in gesondheid wat deur die hervestigingsproses voorsien is, het nie gematerialiseer vir die ontvangers van die laekoste-behuising in hierdie studie nie. Die kwesbaarheid van die gesondheid van die individue in hierdie gemeenskappe hou groot implikasies vir gesondheidsdienste in. Sanitasiefalings, infektiewe siektedruk en omgewingsbesoedeling hou groot openbare gesondheidsrisiko in. Die verdigting wat deur agterplaaskrotte meegebring word asook die gevolge vir munisipale dienste benodig beter bestuur. Beleide oor laekoste-behuising vir armes kort herbeplanning om die realiteite wat saamgaan met verdigting deur agterplaaskrotte te kan hanteer sodat die verwagte verbetering in gesondheid kan materialiseer. Hierdie is inderwaarheid 'n nasionale probleem wat omtrent alle staatsbefondste laekoste-behuising gemeenskappe in Suid-Afrika affekteer. Openbare gesondheid en stadsbeplanning behoort die skeiding tussen hierdie twee dissiplines te oorbrug om sodoende die ongelyke gesondheidstatus van die stedelike armes aan te spreek.

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