The World Population Day was marked on July 11, 2005 with the theme ‘Equality’, which mainly focused on equality between men and women.

Equality in Africa is, however, a bigger challenge even in development aspects other than gender relations and opportunities. For instance, the rapid urbanization occurring in Africa today is widening inequalities in health and social well-being among urban populations in the region. The current population boom in African cities, fuelled mainly by rural-urban migration, has become a major challenge to urban development.

Because of this boom, which is occurring at a time when many economies in the region are registering minimal growth, majority of the urban population in sub-Saharan Africa is unable to find reliable livelihoods, and are consequently forced to live in slum and shanty towns that lack proper housing, water, electricity, sanitation systems, health care facilities, schools, roads, and garbage disposal mechanisms. Many of these slums are located in deplorable environments along river banks, swamps, electric power-lines and industrial waste zones. As a result of these conditions and their marginalization from the existing urban infrastructure and amenities, their health and social indicators have continued to worsen. This has widened the gaps between the urban poor and the urban non-poor, as well as, between the urban poor and rural populations in terms of health outcomes and social well-being.

Even then, the urban population increase is set to continue; it is estimated that by the year 2020, more than half of the population of sub-Saharan Africa will be living in urban areas. Nairobi, for instance, has an estimated 60 per cent of its population living in informal settlements that occupy only five per cent of the city’s residential land area. Nairobi’s population increased from 120,000 in 1948, to 350,000 in 1962, to 500,000 in 1971 and to 2.3 million in 1999. At its current rate of growth, the population of Nairobi is expected to reach five million by 2015. Without substantial and sustained economic growth, this further increase in Nairobi’s population will increase the levels of inequity in the city as majority of the migrants will be drawn to the city’s slum settlements.

This scenario is not just unique to Nairobi. With a population of about one million people, and having grown at about three per cent over the past decade, Blantyre the commercial capital of Malawi represents contexts of low levels of urbanization but still with rampant levels of urban poverty. 65 per cent of the households in the city are living below the poverty line (1998). Accra, with a population of two million in 2000 and a growth rate of 3.7 per cent in the last decade, has seen an increase in the number of the urban poor who in 2000 represented 43 per cent of the city’s population. In 2002, Kampala city, designed for 600,000 people had 1.2 million people, with 39 per cent of the population living in absolute poverty and 43 per cent being unemployed.

Although many development efforts in the region have been concentrated in rural areas on the assumption that the most poor in Africa are in rural areas, research in Kenya has shown that the urban poor are far worse off compared to any other sub-groups in terms of accessibility to proper housing, clean water, and environmental cleanliness which contribute to poorer health outcomes among the urban poor. Studies by the African Population and Health Research Centre have shown that children living in Nairobi’s slums fall sick more often from such illnesses as fever, cough and diarrhoea than children living elsewhere in Kenya. This has been attributed to the poor environmental conditions found in the slum settings.

Despite this, many slum dwellers are unable to access treatment primarily due to cost and the unavailability of public health services in slum settings. Even preventive health services, such as immunization, are less utilized in the slums compared to other areas of Kenya, with less than half of slum children being fully immunized. As a result, children living in Nairobi’s slums have more than double the risk of dying before reaching age five compared to children in other parts of Nairobi, and about 40 per cent higher odds of dying before the age of five than the average Kenyan child. The extreme poverty levels in slum settlements do not only prohibit slum families from accessing quality healthcare services because of their inability to afford the fees charged, but also render them vulnerable to risky behaviour and practices. For instance, half of pregnant women living in slum settlements in Nairobi do not deliver in a health facility despite the fact that they attend antenatal clinics which are usually free of charge (delivery services attract a fee charge). Again, women in slum areas of Nairobi start childbearing at very young ages relative to women in other parts of Kenya. Even though education is seen, even by slum residents, as a viable route out of poverty, children in poor urban communities have least access to schooling. Not only are enrolment rates lower for such children, they also experience higher dropout rates compared to children from non-slum urban and rural settings. A 2000 slum survey revealed that while about 92 per cent of rural and slum girls aged 9-13 were still in school, at ages 14-19, only 24 per cent of girls in the slums were still in school compared to 62 per cent of girls in rural areas. Girls living in slum settings drop out of school due to such reasons as lack of fees and need to work and provide for their poor siblings, among others. Some of these girls engage in prostitution for income generation, which exposes them to the dangers of unwanted pregnancies and HIV/Aids/STI infection.

Reducing the rate of rural-urban migration may require alternative development strategies including targeted rural development programs, development of secondary cities, among others. While these macro-structural changes are being planned and implemented, action to improve the current situation of the urban poor should not be delayed. Deliberate policies and programmes are needed to address the issues of housing and fragile livelihoods that characterize life in urban slum communities across cities in sub-Saharan Africa. Enhancing access to quality healthcare and education for all, including slum dwellers, are critical to bridging the gap and ensuring slum children are not trapped in the vicious cycle of poverty.