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October 19, 2022
Informal networks as sources of healthcare support: How slum dwellers cope with health challenges by talking to each other
Blog written by Chinwe Onuegbu
Access to quality healthcare is a fundamental human right, but this remains a struggle for people living in slums in low and middle-income countries. The term “slum” can be controversial but it is used in this article, in line with a larger project under which the research described in this article is based, to describe poor urban settlements characterised by overcrowding, poor housing structures and an overall shortage of social and health amenities. Globally, one in eight people reside in slums or poor urban settings, and in many African countries, including Nigeria, about 60% or city dwellers live in slums. Public health services in urban cities do not sufficiently cater to people living in the slums, and many are unable to obtain the comprehensive formal healthcare they need.
Staying healthy and fit is particularly essential for people living in slums. Many engage in informal jobs with daily wages, and maintaining health is crucial for maintaining daily household income.
In the face of inadequate formal healthcare services, slum dwellers turn to alternative healthcare options. It is important that we begin to understand these alternatives in order to mitigate any negative consequences and to amplify potential synergies.
My PhD study within the NIHR-funded slum health project
My PhD project was nested within the NIHR funded slum health unit at Warwick Medical School. The unit worked collaboratively with universities in Asia and Africa to map and understand use of health services in slums across both continents.
With my background in Sociology, I recognised the untapped opportunity to explore how health was managed beyond formal medical settings in the slums. My thesis explored a phenomenon known as lay consultation: how people manage illnesses and health challenges by talking to informal network members (e.g. family, friends and neighbours) or other informal online forums or resources (e.g., Facebook friends) beyond medical settings. My study population were the working-age adults in slums in Ibadan (Oyo state), Nigeria, and they were chosen because they were more likely to migrate in and out of the slums, be engaged in work that make them unable to seek care when needed and are likely to own and use mobile devices. These dynamics can shape lay consultation behaviours and network composition. The project adopted a mixed method approach. First, a survey to map how common lay consultation was, which network members were contacted and how influential were informal network members in determining people’s treatment behaviours. Next, interviews were conducted to understand in more depth the connections between speaking to others about a medical problem and actions taken afterwards. The study was done in collaboration with partners from the University of Ibadan, Nigeria.
The study found that most people experiencing illnesses consulted 1-3 network members including family, friends and neighbours. People navigated through the complexities of social life in slums such as having fewer networks due to busy life and difficulties in having trusted or dependable sources of support, to find people they could talk to. Participants rarely used online informal networks, mainly because many did not have access to such devices, had limited digital literacy, or preferred physical networks. The informal consultations were largely unplanned and taken-for-granted as they were ingrained in everyday life. Yet, within those informal conversations, were exchanges of advice and support- some useful and some not, that shaped how people managed illness experiences.
A striking finding from this study was that, despite living in the slums where the harsh conditions may drive over-reliance on informal networks for health maintenance, slum dwellers were highly agentic in using advice or support from others. People had strategies for coping with health challenges which included ability to assess the relevance of advice they received. Occasionally, they consulted other informal health providers such as local medicine vendors (known locally as ‘chemists’) and traditional healers to confirm advice they received from their network members.
We now know from this study that lay consultation, that is talking to informal network members, is a common way of managing illnesses in slums. The conversations- whether intended or unintended- contribute to management of personal health. There is a potential to leverage on informal networks to improve knowledge about health conditions and health care access, thereby contributing to strengthening of the health system in poor urban settings. Informal networks, including those existing online, should be recognised as an integral part of the overall health system, and incorporated into health policies and programmes as a means of increasing the coverage and effectiveness of health interventions.
The next step involves working with collaborators at the University of Ibadan, Nigeria on an intervention around lay consultation for slum communities in Ibadan, Nigeria. Our initial idea is to co-design an online health-resource that would provide formal, verified and accessible health advice for people living in the slums. People feeling ill or having health challenges can consult the online resource as part of steps taken to inform their health-seeking decisions. We will work with policy makers, community members and concerned organisations such as NGOs to co-design and promote the resource.
An internal seed fund grant has been obtained from the Warwick International Partnership fund (IPF) to kick start this project. The funding will be used to:
- Disseminate findings from the PhD to study participants, key stakeholders and the general public,
- Engage representatives of slum communities and public health policy makers at the state level in Nigeria to assess the value of lay consultation as an intervention to improve health outcomes
- Build a multidisciplinary collaborative research team from across public health, information technology and social science and other stakeholders (such as Non-Governmental Organizations) for future research on leveraging lay consultation for health benefits in the slums.
In conclusion, interventions that are bottom-up, innovative and interdisciplinary approaches have the potential to tackle the complex issues in slums. The PhD project and planned intervention discussed in this blog exemplify how the intersection between social science and health science can improve health in slums.
Chinwe Onuegbu is a Research Fellow at the Division of Health Sciences, Warwick Medical School, University of Warwick, UK. She recently completed her PhD in Health Sciences at Warwick Medical School. Her research interests include the social determinants of health in resource-constraint settings, and the role of information and communication technology (ICT) in healthcare in low- and middle-income countries. She is also interested in research communication and hosts a Research chat show on YouTube in her free time.