A Corridor of Contrasts: Urban Health in West Africa
A Corridor of Contrasts: Urban Health in West Africa
This week, African Strategies for Health (ASH)—a USAID-funded, MSH-led project that identifies public health best practices in sub-Saharan Africa and advocates for their adoption—has been attending the International Conference on Urban Health from May 24 through 27 in Dhaka, Bangladesh. At the conference, ASH has been sharing A Corridor of Contrasts, a report compiling photographs and stories of the people living along the West African Abidjan to Lagos transport corridor, which crosses Côte d'Ivoire, Ghana, Togo, Benin and Nigeria.
In partnership with USAID’s Africa Bureau and Bureau of Global Health, ASH sent me and a photographer, Pinky Patel, to West Africa this past January to document life along the Abidjan to Lagos transport corridor. We traveled the majority of the road through Benin, Togo, Ghana, and Cote d’Ivoire, talking with and photographing people from all walks of life with the goal of learning how cities influence health. Our experience is documented in A Corridor of Contrasts.
View a slideshow of images from our experiences along the transport corrdor:
Fifteen years ago, I was a Peace Corps Volunteer in Togo. Some of my memories of the time and place have faded. I struggle to remember the names of my neighbors in the village where I volunteered. It’s hard to remember how to count to ten in the local language or what it felt like to spend an entire day in a hammock with a book. But other memories are still vivid—like going to the port to retrieve a care package waylaid in customs: There was a rickety wooden dock, a tanker or two anchored offshore, and a ramshackle customs building staffed by grumpy rubber stamp-wielding functionnaire. Going to the port was always fun, mostly because a stash of M&Ms and paperbacks was inevitably waiting, but the port itself was no more impressive than the average fishing pier.
When I drove through Lomé again, along the Togolese coast, this past January, I questioned my memories of the small sleepy city I had loved fifteen years ago.
I saw the outlines of massive cranes jutting into the horizon and a mosaic of shipping containers stretched out along the road for a mile. The Lomé I remembered was dotted with single-story stucco buildings, wide beaches, and roadside vendors. It was poor. These cranes and metal boxes belonged in a town far more industrial than the one in my memory.
Perhaps we weren’t in Lomé yet, I thought, as we drove west from the Benin border. I leaned into the front seat of the SUV.
“What is that?” I asked my translator, Dennis, as I pointed to the cranes.
“That’s the port,” he answered.
“The Port of Lomé?”
“Wow,” I said and sat back in my seat.
Fifteen years is a long time, but was it possible that the port had grown so drastically? I popped forward into the front seat again.
“Is the port new?” I asked.
“Oui,” Dennis responded with amusement, finally sensing my shock. “The city is growing. Much has changed since you were last here.”
Indeed, it had.
Lomé, which I often fondly describe as an overgrown beach town, remains a small city compared to its neighbors on the coastal highway stretching between Abidjan to the west and Lagos to the east. Though Togo still has the smallest per-capita GDP of the five countries connected by this the coastal highway, Lomé had obviously grown. I was so happy to see the progress the city had made.
In 2000, most of Lomé’s streets were dirt and sand. Now, they are smoothly paved. Fifteen years ago, the most common vehicles seen in Lomé were ancient Peugeots, often yellow with one blue door, able to be started only by a group of young men pushing from behind while the driver popped the clutch. The doors of every car I saw on this trip matched the rest of the vehicle. Many looked brand new.
I smiled the whole trip through town to the hotel, feeling misplaced pride, like a hometown friend had run off to Hollywood and become a star. The overgrown beach town that I’d loved fifteen years ago was prosperous and thriving. I, obviously, had no hand in that, but I knew her when…
National-level statistics show that in Africa, populations in cities are healthier than in villages. Anyone who has ever visited an urban slum, however, knows that those statistics don’t tell the whole story.
Life in African villages is hard. Life in African urban slums is even harder.
In Benin, Nigeria, and Ghana, the three countries on the corridor where data disaggregated by wealth and residence are available, the urban poor have the highest child mortality rates, the lowest vaccination rates, and chronic malnutrition rates greater than or equal to those of rural populations. In Ghana and Nigeria, the urban poor’s under-five mortality rates increased between the early 1990s and early 2000s, despite declining national figures. At least in Nigeria, living in a slum increases the risk of a child dying before the age of five, even after adjusting for the mother’s education and income.
Despite strong economic growth, between 2000 and 2009, the total number of people living in slums in four of the five countries (data are unavailable for Togo) increased by more than 14 million, just slightly less than the combined populations of New York City, Los Angeles, and Chicago.
As you might imagine, the joy I felt seeing Lomé’s shiny new infrastructure didn’t last long. Though blurred by the trappings of Lomé’s growing middle class, the country’s problems nonetheless persist. As a Peace Corps volunteer, I complained about corrupt customs officers assigning excessive tariffs to care packages. On this trip I saw how the influx of counterfeit medication is devastating the corridor’s pharmaceutical supplies. In 1999, I and my fellow volunteers giggled when a nurse told us that the majority of her family planning clients were nuns. In 2013, the percent of married women using modern contraception was still just 17 percent.
Urban growth is inevitable. As the developing world transitions from predominantly rural to an urban majority, governments, donors, and international partners must shift the focus of their public health interventions to address the population with the greatest needs, those living in urban slums and informal settlements, so that cities can capitalize on the health and prosperity that urbanization promises.