Table 1

Study setting: seven slums in Nigeria, Kenya, Pakistan and Bangladesh

SiteLocationApprox. pop. (000s)*Approx. density (000s/km2)Description of community†
BDDhaka, Bangladesh60.0171Centrally located, well-established area, mostly Bengali, Muslim population working in blue collar jobs (eg, rickshaw pulling, security/house work in nearby wealthy suburbs), with some seasonal migrants (farmers from rural villages). Structures are semi-permanent, with regular demolitions, reconstructions and ongoing site expansion. Residents have variable access to water, sanitation and other services. Pharmacies (n=92) make up most of the 160 recorded health facilities, followed by faith healers, homeopaths/ayurveds and herbalists (n=46). There are only four clinics in the site: one non-governmental organisation (NGO)-run centre providing maternal-child services and three donor-funded clinics providing specialist services for neurodevelopmental disabilities, autism (both child-focused); and palliative care (run mostly by health volunteers), with primary care provided 1–2 times/week by a doctor from the nearby state-run academic hospital. A large research and training centre on the boundary of the site provides specialised clinical care for infectious and non-communicable diseases, maternal/neonatal health and malnutrition.
PKKarachi, Pakistan33.591Centrally located, well-established area. Mixed religion and ethnicity, mostly settled population working in blue collar jobs. Structures are permanent and multistory, with high levels of new construction underway. Residents have variable access to basic services and sanitation. Of the 32 recorded health facilities, most comprise small private clinics run by individuals known as doctors (regardless of formal t qualification) (n=12) and pharmacies/medical stores (n=8), followed by traditional and spiritual healers (n=4). There are two private laboratories in the site and female/polio health workers carry out home visits.
KE1Nairobi, Kenya24.452Located about 12 km from Nairobi Central Business District (CBD). Has a settled community with ethnically segregated and multigenerational residents. Dwelling units are mostly in rows and are made up of timber, mud and tin roofing material. Basic amenities are limited leading to poor sanitation and frequent disease outbreaks. Of 12 primary health facilities, one is government-owned and the rest operate as either private-for-profit or NGO or faith-based primary health facilities. There are also two private-for-profit maternity homes and one NGO-run secondary hospital accessible to the residents, as well as 14 pharmacies.
KE2Nairobi, Kenya44.983Located about 7 km from the CBD, the site consists of a multiethnic population with many economic migrants working in the surrounding industrial area. Structures are mostly made of iron sheet and tin walls with iron sheet roofs. There are limited basic services and poor sanitation. The site is prone to frequent episodes of fire outbreaks often linked to unregulated electricity connections. There are 46 pharmacies and 26 primary health facilities in the site—some operating as stand-alone private-for-profit clinics, NGOs and only one government owned primary health facility. Residents also frequent government-owned primary health facilities and one large subcounty hospital, located nearby (but not in the site).
NG1Ibadan, Nigeria5.85Resettled community on city edge, built around a long, tarred road and central food market. Multiethnic population including many migrants from northern Nigeria. Structures are well-spaced, mostly permanent with variable energy-access, poor sanitation and refuse-filled drains. Of the 32 health facilities documented in the site, most are patent medicine stores (n=22) followed by herbalists and spiritual healers (n=5). There is one state-run primary health clinic, which offers preventive and treatment services, and a few small private clinics, including a maternity home. Some private community birth attendants also serve the community.
NG2Ibadan, Nigeria5.514Centrally located in historical area along an old tarred road, with many residents working as traders in three major markets in the site. Mostly permanent but run-down structures, poor sanitation and refuse-filled drains. The area is poorly planned with a limited road network—many health facilities are not easily accessible during emergencies. Out of 36 recorded health facilities, most are patent medicine stores (n=15) and herbalists and spiritual healers (n=14). There are four 1–2 bed private maternity homes and three state primary health clinics, two of which are affiliated to a university teaching hospital (dentistry and general care).
NG3Lagos, Nigeria8.111Centrally located with multiethnic population, most of whom are educated and employed. Structures are mostly temporary, sanitation and basic services are limited and the site has a higher crime rate than in sites NG1–2. Of the 14 health facilities documented, most are patent medicine stores (n=5) and herbalists and spiritual healers (n=5). There is one state primary health clinic and three private clinics, two of which are maternity homes.
  • *Estimated from data collected in the wider study.

  • †From fieldnotes and healthcare facility surveys.