Effect of low-cost housing on household and environmental health of residents in Phumlani Village, City of Cape Town
Many poor households in South Africa find themselves living in informal housing and only become proprietors of formal housing via the government subsidy scheme for core low-cost housing, thereby also realizing their constitutional right to housing. The subsidy is however limited and it largely determines materials, and construction methods used. Obtaining a formal low-cost dwelling means that basic services such as electricity, sanitation, water and waste collection, is available to the home owner. Formal low-cost housing settlements are commonly located in poor areas and recipients of the housing subsidy are commonly unemployed or have low-income jobs, and frequently originate from informal settlements where services, albeit limited and often communal, were provided at no cost. This study sought to assess the combined effect of relocating from an informal dwelling to a formal low-cost dwelling and receiving individual house-based basic services of electricity, water, sanitation and waste collection, on environmental- and household health. An ecological study design was used whereby data was collected at "baseline" while households were living in the informal settlement, and again at "2 years relocated" i.e. 2 years after moving in to the formal low-cost dwelling. The study population included all households residing in the Phumlani- and Pelican Park- Zeekoevlei Informal area in the year 2000, who were on the waiting list to receive low-cost core housing units in Phumlani Village and were due to be relocated there. Due to the rapid pace at which construction of new homes occurred not all households could be captured whilst living in the informal settlement, i.e. at "baseline". The actual sample subsequently consisted of 53 households at "baseline", and all, i.e. 124 households at "2 years relocated". Data was collected via a structured interview, whereby one respondent per household was interviewed by a trained fieldworker. Positive health improvements were reported by households in terms of personal and household health. Significant (p<0.05) positive improvements were found for households in formal lowcost housing at "2 years relocated" for exposures to: overcrowded living conditions (PR=1.159, 95%CI=1.153 – 3.328); indoor air pollution due to cooking and heating (PR=2.185, 95%CI=1.655 – 2.885); improper household waste management (PR=7.381, 95%CI=4.313 – 12.633 and inadequate sanitation (PR=0.365, 95%CI=0.255 – 0.523). The incidence of childhood diarrhoea episodes decreased significantly (PR=5.588, 95%CI=1.284 – 24.315) at "2 years relocated". Water access, availability and use also increased significantly (PR=0.212, 95%CI=0.125 – 0.358) 2 years after relocation. Factors that did not improve include levels of employment for which households were found to be worse off, with 16% of households having no person employed at "2 years relocated" as opposed to only 2% at ‘baseline”. Other factors remaining unchanged included incidences of respiratory, skin and eye infections amongst children ≤ 6 years old. Although exposure levels to indoor air pollution decreased for some households, this remained present for others as electricity in combination with bio-mass fuels are still being used for heating and cooking. Environmental health conditions for a variety of factors remained unchanged and there was a reversion back to living conditions and habits of the informal settlement. Littering, dumping of waste within the neighbourhood and a high pest presence, remained unchanged. Subsidised formal housing and associated basic services does have a positive impact on health. However, the amount of free basic services, specifically electricity, provided, in lieu of household energy requirements, does not satisfactorily cover all household needs. Factors such as unemployment and low-incomes hamper the household’s ability to maintain the electricity supply as is needed and for this reason alternatives to reliance on electricity should be included in the design and construction of the low-cost house. The manifestation of poor environmental health conditions indicates that provision of low-cost housing by itself is not sufficient to ensure good environmental health. Therefore hygiene promotion should be included as part of the total beneficiary package.