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COVID-19 measures deepening health inequalities in slum communities

  • Health and economic inequalities are exacerbated by efforts to control COVID-19, potentially storing up health problems for the long-term
  • International team led by University of Warwick talked to health workers and residents in slums in Bangladesh, Kenya, Nigeria and Pakistan about the challenges they face
  • Governments should focus on adopting mobile consulting methods and working with informal health services to ensure residents get access to quality healthcare

Efforts to stem the impact of COVID-19 in low to middle income countries could be creating a health time bomb in their slum communities by deepening existing inequalities, according to an international team of health researchers led by the University of Warwick.

Measures to control the coronavirus, such as quarantining and restricting travel, are exacerbating existing economic hardship and limited access to quality healthcare in these communities, creating a ‘perfect storm’ of factors that harm health in the short and long term.

However, the research - funded by the National Institute for Health Research (NIHR) - has identified that adopting mobile consulting and upskilling local providers could be an effective way to provide access to healthcare services for residents.

The conclusions are drawn from research with community leaders, residents, health workers, volunteers and managers working on the ground in slum communities of Bangladesh, Kenya, Nigeria and Pakistan. The study is published in the journal BMJ Global Health.

The researchers define a slum as an area of high population density that lacks sanitation, clean water, safe and durable housing, as well as basic services. The crowded conditions and poor sanitation in slums makes the recommended methods of controlling COVID-19 – such as regular handwashing and social distancing - a challenge in these communities.

In addition, restrictions on travel and the economy limit work opportunities and access to quality healthcare for these communities, both of which often require people to travel long distances.

Those interviewed by the research team reported that residents were turning more frequently to home remedies, pharmacies or patent medicine vendors, traditional healers and private health centres, due to the disruption in health services. Many of these are not part of formal public health systems, and staff are often not qualified.

In some cases residents were reluctant to travel to formal healthcare facilities due to the risk of infection or stigmatisation. Prior to COVID-19, illnesses that were perceived to be common by local health workers included respiratory, gastric, waterborne and mosquitoborne illnesses and hypertension.

However, the researchers argue that less formal services may play a vital part in communicating health information in slum communities, and that focus should be made by governments to ‘upskill’ those workers.

Lead author Professor Frances Griffiths of Warwick Medical School said: “Patent medicine vendors and traditional healers live and work in these neighbourhoods. They are in a good position to advise residents and direct them to formal healthcare when it is in the patient’s best interest, and should be supported in doing this.

“Local healthcare providers should plan for remote consulting to reduce patient contact and reserve personal protective equipment for necessary face-to-face contact.”

To aid in social distancing measures, some health workers and residents reported using their phones for accessing healthcare remotely. The WHO advises the use of mobile consulting to protect health workers and patients but gives little detail about how. However, there is growing evidence of the potential for mobile consulting to enhance provision of healthcare to remote and marginalised populations.

Professor Griffiths added: “These communities are already disadvantaged. There is a danger of them being further disadvantaged by restrictions to control COVID-19 for the wider population and by increasing prices for drugs, healthcare and transport.”

The research team were already investigating access to health care in slum communities as part of the NIHR Global Health Research Unit on Improving Health in Slums. In light of the COVID-19-related lockdowns imposed in each country, the team expanded the scope of the project by rapidly employing a new phase of stakeholder engagement focused on the impact of COVID-19.

  • ‘Impact of the societal response to COVID-19 on access to healthcare for non-COVID-19 health issues in slum communities of Bangladesh, Kenya, Nigeria and Pakistan: results of pre-COVID and COVID-19 lockdown stakeholder engagements’ is published in BMJ Global Health, DOI: 10.1136/bmjgh-2020-003042 Link:
  • This research was funded by the National Institute for Health Research (NIHR) Global Health Research Unit on Improving Health in Slums using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care.


Notes to editors:

Quotes from participants in the research are available in the paper:

This research was commissioned by the National Institute for Health Research using Official Development Assistance (ODA) funding.

The National Institute for Health Research (NIHR) is the nation's largest funder of health and care research. The NIHR:

· Funds, supports and delivers high quality research that benefits the NHS, public health and social care

· Engages and involves patients, carers and the public in order to improve the reach, quality and impact of research

· Attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future

· Invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services

· Partners with other public funders, charities and industry to maximise the value of research to patients and the economy

The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR commissions applied health research to benefit the poorest people in low and middle-income countries, using Official Development Assistance funding.

14 September 2020

For interviews or further information contact:

Peter Thorley
Media Relations Manager (Warwick Medical School and Department of Physics)


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