10 lines of action and 20 measures to mitigate the spread of the coronavirus in informal settlements

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On March 11^th, 2020, the World Health Organization (WHO) classified the new Coronavirus or nCoV-2019 as a pandemic. In Latin America and the Caribbean (LAC), thousands of confirmed cases have already been reported, in almost all the countries of the region, and an increasing number of deaths. The number of cases, the number of deaths and the number of affected countries is expected to continue to increase. Hygiene, social distancing and isolation measures are essential aspects as a public health response to stop the spread of the epidemic. However, the implementation of these measures is an especially difficult challenge for a large percentage of the vulnerable population living in informal settlements, where overcrowded conditions lead to the transmission of diseases^[1], such as asthma^[2].

Worldwide, 863 million people in developing countries live in informal settlements^[3]. They also cannot count on the possibility to wash their hands frequently because they do not have safe water, and neither do they manage waste properly because their neighborhoods do not provide sanitation solutions. At the present time, a large part of this population is faced with the choice between social isolation or hunger since they live on what they earn daily. In these neighborhoods, vulnerable populations such as migrants, women, and other groups such as disabled persons, indigenous peoples, people of African descent, and LGTBQ+ people are often overrepresented.

They also cannot count on the possibility to wash their hands frequently because they do not have safe water, and neither do they manage waste properly because their neighborhoods do not provide sanitation solutions. At the present time, a large part of this population is faced with the choice between social isolation or hunger since they live on what they earn daily. In these neighborhoods, vulnerable populations such as migrants, women, and other groups such as disabled persons, indigenous peoples, people of African descent, and LGTBQ+ people are often overrepresented.

Epidemiological models predict that the impacts of COVID-19 will be particularly high in informal cities^[4] and there will be a major impact on income that will specially affect the poorest groups that depend on day-to-day labor activities, largely informal, to sustain their consumption. Furthermore, the epidemiological models also foresee less effectiveness of traditional containment measures in these settlements^[5], public policy managers must think of alternative and different responses for these areas.

Coverage areas of urban policy for policymakers during the crisis:

1. Provision of infrastructure: facilitate access to installations (if necessary, temporary) that improve hygiene and overcrowding conditions.
2. Reinforce behavioral guidelines: like in formal cities, provide information on the following of protocols and accompany it with monitoring to guarantee compliance. Leaning on neighborhood leaders, adapting the language, and applying behavioral economic techniques can be key to ensuring compliance with protocols.
3. Activate the local economy: provide resources for sectors such as commerce or construction, which lowers their interaction with the rest of the city and helps support small entrepreneurs in the neighborhood.
4. Articulate with other government areas: help citizens access social services and address problems related to the crisis (for example violence, problematic consumption, educational reinforcement, etc.).

10 lines of action and 20 measures to mitigate the spread of the coronavirus in informal settlements

Below are ten lines of action and twenty concrete measures for taking action ordered according to two stages: emergency and recovery. In the first place, emergency management allows contagion to be controlled so that the cost in terms of the quality of life of informal city residents are as low as possible. Subsequently, recovery measures are aimed at the many people who will be in situations of economic vulnerability as a result of isolation and the social costs of losing family members.

Lines of action and key measures for the emergency

To respond to the emergency, we developed five key lines of action, each one with concrete measures and deliverables that can help control the contagion and the reaction in the neighborhoods:

• 

  Axis 1 “DISSEMINATE”: Clear and validated information on prevention measures and emergency response services provided by the state are not readily available in many informal settlements. This is why it is important to develop rapid measures that allow the population to be informed on how to act to avoid behavioral patterns that facilitate the spread of diseases and that are communicated promptly through community leaders.

  • • Measure 1. Train community leaders. Community leaders are credible voices for neighborhood residents and can therefore be rapid and effective communication channels for preventive health protocols and early detection as well as for articulating emergency social assistance (violence, childhood, consumption) and necessary psychological help. Key deliverable: community leaders training workshop.

  Since day one, we agreed on a work system with the neighborhood leaders to jointly implement a prevention strategy. pic.twitter.com/M8I5g3ibJJ

  — BA Integración (@BA_Integracion) March 20, 2020

  • Measure 2. Use public space to disseminate key messages.It is important that key messages on controlling the disease and information on safe behavior (the distance kept when speaking to neighbors, washing hands, avoiding touching the face) are present in the neighborhoods’ public spaces as well as information and support that neighbors can turn to. This can be realized with the inclusion of quick signage or even painted stencils in public space made by neighborhood councils. Key deliverable: plan for dissemination by means of signage in public space.

• Axis 2 “IDENTIFY”:The morphology of informal settlements tends to be very heterogenous and, in order to guarantee an effective intervention, areas of higher risk and treatment should be identified for each settlement by ‘block’ or groups of dwellings that present greater barriers to the implementation of measures or have a high-risk population.  According to data from the National Institute of Statistics and Censuses (INDEC, its acronym in Spanish), the critical overcrowding in Argentina in 2018 (more than three persons per room) affected 1,306,000 people in the country’s main urban agglomerates.^[6]. Likewise, the critical overcrowding rate in Argentinian settlements reached 35% according to Tuñon.^[7].
  • Measure 3. Identify housing units with more overcrowding and unhealthiness. It is possible to work with neighborhood groups to carry out surveys in critical zones, where aid must subsequently be targeted (unhealthy home improvement, relocation for redensification, etc). This can be realized by using community mapping applications that allow for the rapid creation of a critical zone map. An application that can be used is developed by the Center for Sustainable Development (CFSD), which has been applied in Napur with great success. Specifically, The CFSD have managed to reveal the built environment with the development of a mobile-phone application: its condition, land tenure, and the socioeconomic characteristics of the populations living in informal neighborhoods. The application is managed by experienced surveyors and is community-assisted, with a great potential to lower time and money costs. Likewise, platforms exist that already have maps of informal areas which, at the same time, respond to open systems to incorporate new data. This is the case of the initiative Know Your City, or the mapping already realized in Argentina for the City of Buenos Aires called Caminos de la Villa (Trails of the Slum). All of these cases allow georeferenced information to be added to the map from a mobile phone.^[8] Key deliverable: critical blocks map.

    

  • Measure 4. Identify the higher risk population. It is important to know where the population most at risk from the spread of the virus is located (the elderly and people with preexisting medical conditions) and to work proactively in the development of isolation solutions for them. This can be done in collaboration with neighborhood organizations to scale the costs of isolation and protection measures. Key deliverable: surveying of at-risk population.

• Axis 3 “PROTECT” Once the critical zones and the at-risk population are identified, we must begin to think of how to protect the community through actions that facilitate isolation and measures of control, especially hygiene, health infrastructure through housing solutions, and basic temporary infrastructure such as water and sanitation posts.
  • Measure 5. Enabling care and isolation spaces for the higher risk population. The relocating of the at-risk population should not wait for the virus to spread. Based on the survey of the at-risk population, places must be found to enable or install temporary spaces for the isolation and care of older adults and the population with pre-existing conditions that follow sanitation protocols and bring food and services to them to avoid contagion. The necessary installation works can be carried out by neighbors to limit access with community outsiders and to ensure that the inverted resources remain in the community. In the cases where it is not possible to designate safe spaces within neighborhoods, mechanisms can be considered to relocate the neighbors outside of these, paying rents temporarily. Following the spread of COVID-19, for example, the National Sports Secretary (SND, its acronym in Spanish) and the Ministry of Social Development (MIDES, its acronym in Spanish) of Uruguay jointly decided to request shelter for the homeless or people who are of the at-risk age in sports facilities. The basketball stadium Palacio Peñarol was the first to provide its facilities and the action is being replicated in other sports centers.^[11] Key deliverable: enabling of sanitary care spaces.

    

  • Measure 6. Installation and construction of temporary hygiene points in public space It is important to bring to the neighbors sources of clean water where they can wash their hands and to provide hand sanitizers and cleaning products. Based on the critical block map, strategic locations can be selected for the placement of temporary hygiene points that serve both to deliver products and to wash hands. The initiative Juntos por la Salud (Together for Health), promoted by the government of Mexico, is an applicable example to this effect. Its aims to provide information and preventive health services, in which mobile units are made available through equipped trucks that provide general guidance and that travel to the sectors where greater vulnerability is identified^[12]. Another example of the identification of temporary hygiene points is the program Reblocking, which studies the typology, very different from formal cities, of each neighborhood. It considers access points, the relation between them, and the relative interior position of each block, to then, through the application of an algorithm, identify disconnections with the urban infrastructure and, at the same time, suggest locations for infrastructure that minimally interfere with what already exists^[13]. Key deliverable: enabling temporary hygiene points.

    

• Axis 4. “CONNECT” Connection is a key point to limit circulation in neighborhoods and to allow operation and communication between neighbors. In informal settlements, 72% of children and adolescents (from 5 to 17 years old) do not have their own mobile phone.^[14] These numbers drop to 54% for the medium socioeconomic level and 43% for the upper level. According to the same source, 55% of children do not use the internet in settlements while in the middle socioeconomic level it is only 32% and in the upper level only 13%.  Likewise, young people from poorer households have less of a probability of having access to a computer and to acquire digital habits than their peers from more well-off households.^[15], According to a 2017 Organization for Economic Co-operation and Development (OECD) analysis based on INDEC data,^[16][17]in Argentina internet access is 47% for households with no educational background and 94% for the segment with the highest level of education. It is important to connect people digitally to generate information, communication, education, and work in the household.
  • Measure 7. Deliver mobile internet devices to increase digital connectivity in households. A quick solution to ensure connectivity in households is to deliver mobile internet devices so that residents can connect to the network. This can decrease the cost that families have to face to stay connected and reduce the need to circulate. This has been applied in the initiative Atalaya Sur, framed in the Proyecto Comunidad, with the aim of appropriating technology and reducing the digital gap. The creation of a community network was promoted: a WiFi network developed through a collaborative process that, thanks to a technical solution combining fiber optics and radio frequency, managed to extend the initial pilot project to cover the settlement’s main streets in which around 30 thousand people live, the Villa 20, in the city of Buenos Aires.^[18] Key deliverable: distribution of mobile internet devices to households.
  • Measure 8. Install secure connectivity points in public spaces. Many neighbors do not have access to the internet and restricting circulation inevitably leaves them disconnected. For this, it is important to locate secure connectivity points in public spaces where telephone and internet can be accessed following the no-proximity protocols in public space. This has been tested in migrant camps: in Rwanda the Kiosco Solar Móvil (Mobile Solar Kiosk), an integrated system to charge small electronic devices using solar energy, was developed. It allows the load of twenty devices simultaneously and sixty units per day. In some cases, WiFi service is also provided through backpacks that emit signals.^[19] Another example is the charging and WiFI stations developed by NetHope. In addition to internet access, these stations share information materials and provide connectivity kits for non-profit organizations that are working in other areas.^[20]  Key deliverable: distribution of mobile internet devices in public spaces.

    

• Axis 5. “CONTROL” Compared to formal cities, total isolation is barely viable in informal settlements, so strategic measures must be sought to control circulation flow in neighborhoods through at-home care and a staging of the centers of agglomerations.
  • Measure 9. Bring businesses to neighboring households. In coordination with community leaders, small businesses can be worked with to define attention and distribution zones inside the neighborhoods so that goods arrive at houses and people do not need to travel. The case of Carteiro Amigo (Friendly Postman) could be taken as reference, a community mail service with an algorithmic mapping used in Río de Janeiro’s favelas. Families can register for the service and thereby create an address and identification number to deliver and receive mail and packages directly to their home in informal contexts with organic urban plots, streets often without name or logical number sequences.^[21]  Key deliverable: business distribution plan by sector.

    

  • Measure 10. Bring social services to the neighborhood. It is important to minimize the circulation of neighbors searching for social services and assistance. For this, critical block maps can be worked with to find strategic locations for information points and for the provision of social services. The example of the Pulse Lab Jakarta initiative, which, through real-time analysis and big data, uses data sets extracted from mobile communications, social networks, and information obtained from complaint systems at the sub-national level, was useful to visualize various trends, concerns, and priorities of citizens;^[22] or the program El Estado en Tu Barrio (The State in your Neighborhood) from the Ministry of Social Development of Argentina, which brings state services to neighborhoods through temporary structures. Key deliverable: location plan for social services providers.

Lines of action and key measures for recovery

Once the emergency period is finished, informal neighborhoods will face the challenge of reactivating productivity and reacting to the multiple consequences of confinement. To work during the recovery stage, we determined five key lines of action, each one with concrete measures and key deliverables that can help reactivate the local economy and navigate a period of partial isolation, in which a secure transition to normality is key.

• Axis 6. “REACTIVATE”In isolation, the income of informal cities will be affected and therefore the internal consumption of goods and services will affect the neighborhood economy. To face this, it is key to think of resource injection methods for small- and medium-sized business that are the most affected.
  • Measure 11. Develop community initiative project funds. It is fundamental to help communities to develop necessary projects in each neighborhood during the recovery period according to their idiosyncrasies. The provision of non-repayable funding, credits, or savings funds management, can be a great empowerment for communities in the reaction period to carry out housing or infrastructural community projects. The Asian Coalition for Community Action is an example of how it can work in more than 19 countries.
  • Measures 12. Financial and technical assistance to recover productive entities.Neighborhoods tend to have a rich and dynamic economic fabric centered in the trade, production, and provision of services. The reactivation of these productive units can be managed directly through specific programs or in conjunction with existing technical assistance programs and financial facilities that provide some liquidity to restart.

• Axis 7. “TRAIN” Given that the return to normality will be progressive and that economic and academic reactivation accompany this process, the recovery period is an opportunity to train people from the neighborhoods to develop products that are useful during this stage and to work with students who have fallen behind.
  • Measure 13. Strengthen educational activities for students who have fallen behind. The closure of education centers together with the lack of digital connectivity in homes will cause many young people to fall behind in their studies and to become detached from them, which could lead to school dropouts. To support the most affected students, tutoring models (with a tutor or with peers) in the centers or at home can be used. This has been done in Projecte Rossinyol, an intercultural mentorship program in Spain. The objective of this project is to create socio-educational integration through i) reducing dropout rates, ii) increasing student confidence, and iii) improving educational levels. For this, university students are trained as mentors and are responsible for accompanying adolescents in disadvantaged systems to offer them cultural, educative, and social opportunities.^[23] 
  • Measure 14. Train residents in new fields that emerge from the crisis.Once the emergency has passed, the process of control and recovery from the pandemic will be long and will require new skills related to new needs. Communication, health care, protocol management ,or logicistics related professions can be reinforced in neighborhoods through training programs.

• Axis 8 “RECONFIGURE” During the period of returning to normal, it will be important to rearrange the neighborhood spaces to allow for their functioning through temporary infrastructure and healthy public spaces and thus reducing the effects of isolation during the recovery stage without exposing people.
  • Measure 15. Reconfigure temporary infrastructure in permanent solutions. In the cases where the temporary infrastructure installed during the emergency has been useful for the neighborhood, they can be considered to be transformed into permanent infrastructure through local construction to maintain its designated use or a different use decided by the community.
  • Measure 16. Reconfigure public spaces. During the recovery period, it will be necessary to maintain the safety distance as well as other preventative measures to avoid a new epidemic outbreak. Adapting public spaces to make them spacious, open, and easy to clean and maintain becomes a particularly important task.

• Axis 9. “MITIGATE” The isolation period will have consequences in neighborhoods, and so it will be important to think of mechanisms that mitigate the economic and psychological effects of the crisis for the most affected families, supporting them with medium-term solutions.
  • Measure 17. Finance rental housing for periods of partial isolation. Although the reactivation period can be an opportunity to focus on improving the worst housing situations, those families that are living in especially critical conditions, whether due to housing quality, age distribution, or a situation of critical overcrowding, can relocate to rental housing during periods of partial isolation.
  • Measure 18. Monetary and nutritional support. Among the reasons why people self-build their housing in informal settlements is the lack of stable income, which often comes from informal work that does not have social provisions such as unemployment insurance for when the economic activity slows down. In a quarantine and social distancing scenario, people who work for a daily income face either going out to work and putting their health and that of the community at risk or not having enough resources to eat. Recognizing this social risk, the Alcaldía de Bogotá activated the program Bogotá Solidaria en Casa (Solidary Bogota at Home), focusing on lower income families and providing a subsidy from national and mayoral resources equivalent to U$S 50 through monetary transfers (including mobile phones), the distribution of vouchers redeemable with credit cards, and in-kind contributions such as family basket deliveries for the nutritional security of families[24]. They also activate local and national channels for donations so that the citizen, civil society, and the private sector can support families that do not have enough resources to obtain supplies during a health crisis.[25]

• Axis 10. “RECONDITION” Given that many structures will be temporarily built to respond to the emergency, it is important to think of how they are going to be reconditioned for new uses or how they can improve unsanitary housing for the partial isolation period.
  • Measure 19. Reconditioning of spaces for social distancing and health. The infrastructures created during the emergency as temporary solutions for health care or to facilitate social isolation can be integrated into the neighborhood’s urban fabric as community equipment.
  • Measure 20. Housing improvements for healthy spaces. During the recovery period, many people in risk situations must maintain partial isolation. It is key that housing has adequate light and ventilation, therefore it will be necessary to think of mechanisms to improve housing in a strategic way and with the support of residents.

 

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América Latina y el Caribe es una de las regiones más desiguales del mundo, donde el 20% de su población vive en asentamientos informales y alrededor del 50% pertenece a la economía informal. En el contexto de una crisis sanitaria y socioeconómica, ¿qué hacemos donde las soluciones tradicionales no funcionan? En un reciente webinar de la Red de Ciudades de @el_bid analizamos cómo mitigar la propagación del coronavirus en la ciudad informal, y particularmente en los asentamientos informales, junto al Profesor Rahul Mehrotra, Decano Designado de la Facultad de Diseño y Director del Departamento de Urbanismo y Planificación de la Universidad de Harvard. Muchas gracias & many thanks Prof. @architectmehrotra for sharing your knowledge and thoughts! . #urbanismo #urbanism #espaciopublico #publicspace #vivienda #housing #covid19 #coronavirus #desarrollourbano #urbandevelopment #americalatina #latinamerica #arquitectos #architec #pandemia #pandemic #socialinclusion #cityplanning #planificacionurbana #infraestructura #urbanizacion #inclusionsocial #urbanización #urbanization #urbanização #slum #humansettlement #arquitecturaydiseño #architecture #socialarchitecture @harvardurbandesign @harvardurbanplanning @harvardgsd @harvard

A post shared by BID Ciudades Sostenibles (@bid_ciudades) on May 4, 2020 at 4:47pm PDT

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^[1] See the following studies: Webb P.M., Knight T., Greaves S., Wilson A., Newell D.G., Elder J. y Forman D. “Relation between infection with Helicobacterpylori and living conditions in childhood: evidence from person to person transmission early in life”, in British Medical Journal, vol. 38 (1994); (ii) Fonseca W., Kirkwood B.R., Victora C.G., Fuchs S.R., Flores J.A. y Misago C. “Risk factors for childhood pneumonia among the urban poor in Fortaleza, Brasil: a case-control study”, in Bulletin World Health Organization, 74, (1996), 199-208; (iii) Murtagh P., Cerqueiro C., Halac A., Avila M., Salomon H., Weissenbacher M. “Acute lower respiratory infection in Argentinian children: a 40 month clinical and epidemiological study”, in Pediatric Pulmonology, 16 (1993), 1-8.

^[2] For evidence of the prevalence of resipatory diseases see: Benicio, M.H.D.A., Ferreira, M.U.,Cardoso, M.R., Konno, S.C., Monteiro, C.A. “Wheezing conditions in early childhood: Prevalence and risk factors in San Paolo, Brazil”, in Bulletin of the World Health Organization, 82, (2004), 51-52.; Unger, A., Riley, L.W. “Slum Health: From Understanding to Action”, in PLoS Med, 4 (2007), 10; Matte, T., Jacobs, D. “Housing and health: Current issues and implications for research and progress”, in Journal of the Urban Health Bulletin, New York Academy of Medicine, 77, (2000), 7-25.

^[3] According to a document from the Development Bank of Latin America (CAF), a third of the population in developing countries lives in informal settlements, whose population has increased from 650 million in 1990 to 863 million in 2012 (Alves, 2018). For Latin America, Para América Latina, this is 21.1% of the urban population as reported by UN-Habitat in 2014 (Fuente: Open Data from UN Habitat Global Urban Observatory). Likewise, the IDB technical note 604 reports that 60% of the region’s por live in informal settlements (Brakarz y Jaitman 2013 ).

^[4] Chen et al “Effect of modelling slum populations on influenza spread in Delhi”, BMJO, 2016

^[5] Adiga et. al “Disparities in spread and control of influenza in slums of Delhi: findings from an agent-bsaed modelling study”, BMJO 2017.

^[6] Aggologrmates refers to the 31centers with more than 100,000 in habitants with high density and high health and environmental risk, and it houses 62% of the national population. Source: “Indicadores de condiciones de vida de los hogares en 31 aglomerados urbanos”, Informes Técnicos vol.3, n83. Instituto Nacional de Estadística y Censos (Segundo Semestre, 2018).

^[7] Tuñon, I. “(In)equidades en el ejercicio de los derechos de niñas y niños. Derechos humanos y sociales en el período 2010-2017”, in Serie EDSA Agenda para la Equidad (2017-2025), Observatorio de la Deuda Social Argentina, Fundación Universidad Católica Argentina (2018).

^[8] https://www.cfsdindia.org/, https://caminosdelavilla.org/, https://knowyourcity.info/

^[9] https://www.elpais.com.uy/informacion/salud/palacio-penarol-pronto-recibir-personas-edad-riesgo-coronavirus.html

^[12] https://www.juntosporlasaludvds.org/

^[13] Christa Brelsford (Santa Fe Institute) + Taylor Martin (Oak Ridge National Laboratory) + Joe Hand (Departamento de Matemáticas, Sam Houston State University) + Luis Bettencourt (Mansueto Institute for Urban Innovation and Department of Ecology and Evolution, University of Chicago) + colaboraciónn de Slums Dwellers International (SDI) y Community Organisation Resource Centre.

^[14] Tuñon, I. “(In)equidades en el ejercicio de los derechos de niñas y niños. Derechos humanos y sociales en el período 2010-2017”, in Serie EDSA Agenda para la Equidad (2017-2025), Observatorio de la Deuda Social Argentina, Fundación Universidad Católica Argentina (2018).

^[15] According to the following studies: Basco, A.I., Carballo, M. (ed.). “Compás millennial: la generación Y en la era de la integración 4.0.” INTAL (Nota técnica del BID : 1283; Julio, 2017); OECD. “Revisión del gobierno digital en Argentina. Acelerando la digitalización del sector público” (2017); Galperin, H., Cruces, G., Greppi, C. “Gender Interactions in Wage Bargaining: Evidence from an Online Field Experiment” (Septiembre, 2017). Available online: https://ssrn.com/abstract=3056508 o http://dx.doi.org/10.2139/ssrn.3056508

^[16] Galperin, Hernan and Cruces, Guillermo and Greppi, Catrihel, Gender Interactions in Wage Bargaining: Evidence from an Online Field Experiment (September 20, 2017). Available at SSRN: https://ssrn.com/abstract=3056508 or http://dx.doi.org/10.2139/ssrn.3056508

^[17] OECD (2017) “Revisión del gobierno digital en Argentina. Acelerando la digitalización del sector público”

^[18] http://www.proyectocomunidad.com/atalaya-sur/ – http://www.villa20.org.ar/

^[19] http://www.a-r-e-d.com

^[20]http://media.ifrc.org/global-review-on-migration/smart-practice/charging-and-wi-fi-stations-for-migrants-along-trails-europe/

^[21]  http://www.carteiroamigo.com.br/

^[22] https://pulselabjakarta.org/

^[23] http://www.projecterossinyol.org

[24] link http://www.sdp.gov.co/noticias/bogota-solidaria-casa-0

[25] links https://bogotasolidariaencasa.gov.co/ y https://coronaviruscolombia.gov.co/Covid19/ayudar-nos-hace-bien.html