Category: Africa

Source: The Conversation – Africa – By Elaine Nsoesie, Assistant Professor, Department of Global Health, Boston University School of Public Health, Boston University

A new book called Urban Health in Africa explores how rapid urbanisation across the continent shapes public health and wellbeing. Drawing on diverse research and case studies, the book reframes African cities not just as sites of challenge, but as places of innovation, resilience and opportunity.

We spoke to global health researcher Elaine Nsoesie and urbanisation and wellbeing sociologist Blessing Mberu, co-editors of the book, to explore why the stories of African cities matter, and what it will take to build inclusive, healthy urban futures.

What’s one thing about urban life in Africa that you think more people should appreciate?

African cities work, but not always like cities in other regions. In the book, we quote the following text by AbdouMaliq Simone, who works on issues of spatial composition in urban regions:

In city after city, one can witness an incessant throbbing produced by the intense proximity of hundreds of activities: cooking, reciting, selling, loading and unloading, fighting, praying, relaxing, pounding, and buying, all side by side on stages too cramped, too deteriorated, too clogged with waste, history, and disparate energy, and sweat to sustain all of them. And yet they persist.

That persistence matters. Too often, discussions about African cities focus only on their problems. These include inadequate infrastructure, rapid urbanisation and informal settlements. What gets lost is their remarkable functionality and their diversity. No single city can represent the entire continent. Lagos is not Nairobi; Accra is not Dakar. Each has its own history, governance structures and contemporary challenges. Treating them all the same flattens this complexity.

Yes, these cities face serious challenges. But they’re also home to innovative urban experts, effective policy solutions and technological breakthroughs designed for their specific contexts. The question isn’t whether African cities work. It is whether we’re paying attention to how they work, documenting how they are addressing challenges related to health and learning from their solutions.

Was there a story or example that really stayed with you?

When we set out to write this book, we knew we had to start with history. You can’t understand health in African cities today without understanding how colonialism shaped the built environment and urban citizenship. We wanted readers to see how historical forces combined with rural-urban migration, population growth and policies created the urban landscapes affecting millions of lives today.

Read more: Harare’s street traders create their own system to survive in the city

Our second goal was to map the social determinants of health – the conditions of the environments in which people are born, live, play, work and learn – shaping African cities. We focused on informal settlements and slums because they’ve become defining features of urban Africa. We examined how residents navigate daily struggles: inadequate housing, water and sanitation; air pollution; transportation; food insecurity. We didn’t want to present these as isolated problems. We wanted to show how they’re interconnected challenges that affect many communities.

One of our favourite chapters is in this section. The chapter explores how transport affects health in African cities – both the risks and the benefits. For example, the availability of transportation increases access to hospitals and schools, while vehicles also cause traffic injuries and air pollution. The authors also discuss distinctive forms of public transport that African cities share that you won’t find in most other parts of the world.

Motorcycle taxis, for example, have different names. They are called boda bodas in Kampala, okadas in Lagos. Commuter minibuses are referred to as poda-poda in Freetown, trotro in Accra, daladala in Dar es Salaam, matatu in Kenya, car rapides in Dakar, kamuny in Kampala, gbaka in Abidjan, esprit de mort in Kinshasa, candongueiros in Luanda, sotrama in Bamako, songa kidogo in Kigali.

The chapter captures a major theme in the book; while these cities are different, policies that have been effective in one city can be adopted to address the needs of residents in another city.

Read more: South Africa’s minibus taxi industry runs on social bonds – reform must accept this

In addition to the social determinants of health, we had another section that addressed Africa’s unique demographic reality: these cities are young. We dedicated sections to how urban environments shape young lives, particularly around sexual and reproductive health. We also highlighted the growing epidemic of chronic diseases like obesity, diabetes and hypertension. Studies have shown an association between the rate of urbanisation in Africa and an increase in chronic diseases because of issues such as adoption of unhealthy western diets, lack of spaces to exercise, and sedentary behaviours.

To showcase how some cities are addressing the challenges related to the social determinants of health, we included case studies on air quality in Kampala, new mental health initiatives in Yaoundé, an approach to reducing school dropouts in Arusha, integrated planning transforming informal settlements in Nairobi, and digital health innovations. The case studies demonstrate that effective solutions incorporate community voices and the local context.

Your book outlines a future for urban health in Africa. What do you see?

Our final chapters make explicit what we believe must happen next. We need public health professionals, urban planners, physicians, nurses, community health workers, policy advocates and water and waste managers working together. We need educational programmes focused specifically on urban health. Most critically, we need strong local, national and regional governance to turn plans into reality.

Read more: Youth workers are spreading health messages on social media: how to support what they do in South Africa

But we also need to elevate youth voices, ideas and innovations across the continent. According to United Nations estimates, about 40% of Africans were under 15 in 2020, and nearly 60% were under 25 – the largest proportion of young people of any region worldwide.

Young people are shaping African cities and they will live with the consequences of whatever decisions are made today.

What motivated the publication of this book, and why now?

When we started this project there weren’t any books on urban health in Africa written by Africans working to address the various challenges faced by urban residents. An estimated 46% of Africa’s 1.3 billion people live in urban areas. Africa is also the continent with the fastest urbanisation rate, with 50% to 65% of the population projected to live in urban areas by 2050. Despite having urban challenges similar to those in other regions, some of the issues that cities in Africa face are unique.

We wanted to bring together researchers and practitioners with diverse expertise and deep knowledge of the challenges people face in cities. We wanted to look at these challenges, the policies that have been effective and recommendations about what must be done to improve the health of residents.

– African cities are diverse and thriving, but face many challenges. How to make them healthier
– https://theconversation.com/african-cities-are-diverse-and-thriving-but-face-many-challenges-how-to-make-them-healthier-274647

Source: The Conversation – Africa – By Siyabulela Christopher Fobosi, Senior Researcher, UNESCO ‘Oliver Tambo’ Chair of Human Rights, University of Fort Hare, University of Fort Hare

In many rural parts of South Africa, getting to a hospital, school or workplace depends on the condition of a gravel road. When that road collapses during rain or potholes make it impassable, the consequences are immediate: ambulances cannot reach patients, children miss school, workers lose income.

This is the reality for many communities in the Eastern Cape, one of South Africa’s poorest provinces. Here, four out of every five children live in households whose monthly income isn’t enough to meet their basic needs. In 2024, nearly 50% of children in the Eastern Cape lived in households without a single employed adult – the highest rate in the country.

A recent study in one Eastern Cape community documents that the roads are so degraded – from poorly maintained gravel to crumbling asphalt – that they actively cut residents off from healthcare, education and markets.

The problem is often described simply as a failure of service delivery. But this explanation is incomplete. My research as a sociologist with a particular interest in the transport sector suggests that the decay of rural roads reflects something deeper. It is not a breakdown, but a continuation. A regime of inequality continues to shape infrastructure development long after the end of apartheid.

The poor infrastructure is a direct legacy of apartheid’s spatial planning, which from 1948 to 1994 systematically underdeveloped rural “homelands” like the former Transkei (now in the Eastern Cape) to confine and control the Black majority.

Today’s neglected roads still physically isolate communities, restrict their access to markets and services, and demonstrate how the state, through inaction and underfunding, maintains the barriers established by its predecessor.

In my study, I drew on the 2023 inquiry conducted by the South African Human Rights Commission into the state of rural roads in the province. The inquiry was convened in response to a pattern of complaints received by the Commission from rural communities over several years. I served on the panel for this inquiry, which heard oral testimonies from affected community members and farmers, and received detailed written submissions from key stakeholders.

A key finding was that only 9% of the province’s roads are paved, compared to a national average of 25%. The inquiry found that poor road infrastructure limits people’s ability to access essential services enshrined as constitutional rights, such as healthcare, education and social support.

Roads as a system of power

Infrastructure is often seen as neutral – roads, bridges and railways that simply allow people and goods to move. But infrastructure also reflects political choices about who receives investment and who is left behind.

A snapshot of this is evident in the provincial budget for roads in the Eastern Cape. The human rights inquiry report reveals that the Eastern Cape Department of Transport receives an annual allocation of about R2.5 billion (almost US$150 million) for its road network. But the department itself estimates a capital backlog of R30.5 billion just to bring roads up to an acceptable standard.

While the annual budget allows for upgrading only about 42km of road per year (at an average cost per kilometre of R18 million, or over US$1 million), the province has over 36,000km of unpaved roads – a legacy of apartheid-era neglect.

This is not a technical failure. It is a political choice to perpetuate a system where the most vulnerable communities remain isolated.

Three decades after democracy, many of these patterns remain visible. And the effects continue to ripple through everyday life.

The everyday harm of infrastructure decay

For rural residents, road deterioration is not just an inconvenience. It produces what scholars call slow, everyday harm.

Ambulances struggle to reach remote villages, delaying medical care. School transport is disrupted when buses cannot travel on damaged roads. Farmers face difficulties transporting goods to markets. Public transport services often avoid areas where roads are impassable.

These impacts accumulate over time, affecting livelihoods, health and dignity.

In some cases, residents must walk long distances because vehicles cannot reach their communities. During heavy rains, entire villages can become temporarily isolated.

This situation highlights how infrastructure shapes social inequality. When roads deteriorate, the burden falls disproportionately on people who already face economic and geographic marginalisation.

Why the problem persists

Several factors contribute to the continued deterioration of rural roads.

The first is the massive historical backlog.

Second, the funding model is fundamentally inadequate. The inquiry report details that the Eastern Cape relies almost entirely on the Provincial Roads Maintenance Grant. Provincial Treasury itself argued that the national funding formula, based on population, fails to account for the province’s vast geography and historical infrastructure deficit.

Third, governance and capacity issues are rife. Submissions from the Auditor General highlighted repeated financial mismanagement within the Department of Transport, including fruitless and wasteful expenditure on contracts. Municipalities, tasked with maintaining local roads, often lack the resources and the technical capacity to effectively use management systems.

Fourth, the impact of climate change is accelerating decay. The inquiry heard from multiple municipalities about how increasingly severe weather events overwhelm their ability to respond.

Finally, a lack of coordination and accountability. The report notes that despite clear legal mandates, there is often poor planning between the provincial department, the national roads agency and municipalities, leading to misaligned priorities and slow project implementation.

Urban areas and major highways receive priority funding because they are economically strategic. This is not a uniquely South African phenomenon – it is a global pattern. The World Bank estimates that 80% of the world’s poorest people reside in rural areas.

Read more: Land reform in South Africa is failing. Ignoring the realities of rural life plays a part

Rural roads tend to receive less consistent maintenance. When maintenance is consistently deferred, costs climb.

Meanwhile, funds that could be used for this upkeep are often tied up elsewhere. A recent Auditor-General’s report found that municipal infrastructure projects nationally face average delays of 17 to 26 months, and all South African municipalities combined spend only 4% of the total value of their assets on maintenance.

These numbers show that the deterioration of rural roads is not an accident, but the predictable outcome of political choices not to invest in marginalised communities.

Communities stepping in

Despite these challenges, rural residents are not passive victims of infrastructure neglect.

Across parts of the Eastern Cape, communities have organised to repair roads themselves. Residents fill potholes, clear drainage channels and use local materials to stabilise damaged sections of road.

These efforts are often informal and rely on collective labour rather than state support. They reflect what scholars sometimes call “insurgent infrastructure” – grassroots initiatives that emerge when the state fails to maintain essential services.

While such actions demonstrate community resilience, they also highlight the scale of the problem. Road infrastructure is expensive and technically complex to maintain. Community efforts cannot substitute for sustained public investment.

Rethinking infrastructure policy

Addressing rural road deterioration requires more than occasional repairs. It demands a broader rethinking of infrastructure governance.

First, rural infrastructure should be treated as a development priority, not a secondary concern. Reliable roads are essential for economic participation, access to services and social inclusion.

Second, government agencies need stronger coordination to ensure that road maintenance responsibilities are clearly defined and effectively implemented.

Finally, policymakers should recognise the knowledge and experience of rural communities themselves. Residents often understand the local terrain and infrastructure challenges better than distant administrators.

Beyond service delivery

If rural roads continue to deteriorate, the consequences will extend far beyond transport. They will reinforce social and economic exclusion for already marginalised communities.

Recognising infrastructure as part of a broader regime of inequality is an important step towards addressing these challenges.

– Bad rural roads in South Africa aren’t just a technical problem – they block people’s rights: report
– https://theconversation.com/bad-rural-roads-in-south-africa-arent-just-a-technical-problem-they-block-peoples-rights-report-278337