Governments come and go... the community abides / by Jorge E. Hardoy

Governments come and go ... the community abides Photo W HO/UNICEF/B. Wolff by Jorge E. Hardoy Wl ore than 15 years ago, two Latin American researchers related how 50 volunteer groups had offered their services and contributions to a squatter set- tlement outside Lima, Peru. Sud- denly, the importance of collective action was realised. Many such efforts deserve uncon- ditional praise and support. They have helped millions of people to learn to read, find skills, improve their homes and health, and de- 26 velop a higher capacity to run their organizations, with the result that pressure has been put on national and local governments to find ad- equate solutions to the more urgent problems. In many cases such efforts have provided openings to the world outside. I would like to believe that the number of viol- ent expulsions of squatters had decreased in recent years as a result of a public awareness created by the activities of community groups working with nongovernmental or- ganizations. Democratic govern- ments accept these activities and often support their actions. Moreover, I am sure that urban squatters are surprised by the num- bers of people from national and international charities, religious groups, political parties, university extension programmes, inter- national agencies and special public programmes that visit their settlements. W ORLD HEALTH, July 1987 ,- Nevertheless, hundreds of mil- lions of people remain in dire straits. It is easy to forget that the governments of at least half of the Third World nations do not always fully represent the interests and aims of their people and that social movements are frequently un- heeded. For various reasons, even elected governments hesitate when asked to decentralise decision-mak- ing and support local urban and rural community groups, whose vigour can broaden the base of participatory democracy. There is a direct link between poverty and cholera, viral hepatitis, typhoid fever, schistosomiasis, diar- rhoea! and parasitic diseases, tuber- culosis, anaemia and many other diseases that are carried by water or related to poor sanitation, over- crowding and poor diet. It follows that much can be done through a better coordination of the pro- grammes of agencies responsible for the improvement of health and the environment. Such levels of bureaucratic incompetence, dupli- cation, wastefulness and sectoral bias have been reached that it is easy to despair. "Poor housing is not given the attention it merits as a cause of disease. Low-cost rehabilitation, new building materials, the gradual removal of disease vectors, and better domestic hygiene- these all constitute a means to im- prove the community's envi- ronment and the community's health." Professor Abel Wolman, Emeritus Professor at the Johns Hopkins University, Baltimore, USA. writing in World Health Forum, Vol. 7, No. 2, 1986. With some exceptions, the United Nations system can hardly claim a better record. It has become too large, too complex, too slow, and too closely linked to govern- ments, forgetting that possibly half of the urban areas in the Third World have been built by the people themselves, independently of official plans, norms and standards. It is important to witness the pragmatism of communities. Much W ORLD HEALTH, July 1987 could be learnt from their actions. Governments come and go, rep- resentatives of international and public agencies explore the pos- sibilities of starting projects, and countless well-intentioned people approach communities to exchange views about improvement pro- grammes, but, at the end of the day, most programmes are selected and priorities adopted without consult- ing the people and their organiz- ations. People in communities have a very clear idea of the type of financial and technical assistance they need, but officials often see things differently, and aid may be almost impossible to obtain. Clearly, the worst environments cause immense suffering and may even make it impossible to earn an adequate income. Much could be done to improve them, but they will not disappear until extreme pov- erty is eradicated. This can no longer be seen as something to be achieved through international aid, nor even as the exclusive responsi- bility of Third World governments; rather it must be viewed as a task for the whole world. To emerge from the present situ- ation, it is essential to engage new people and bring about a radical change of attitudes. Attempts to improve environments of poverty have become bogged down because they are based on increasing the role of central governments, which too often are not inclined to work with the people. Central governments and international agencies have an important role to play, but do not have a monopoly of wisdom. We should be more ready to work with community organiz- ations and nongovernmental organ- izations. Loans of US $100,000 to a hundred community organizations will have a far greater impact on the living conditions of the poor than a $10 million loan to the government of the same country for conven- tional housing or a site and services project. And the chances of recov- ering the smaller loans will probably be higher. If nations and agencies take the view that this approach is out of the question, we may as well forget the envir- onments of poverty and all the rhetoric about the importance of community organizations and non-governmental organizations in improving health. • ·where' small is, not.beautilul ''C' ;~~o~: un~r,~~;on~~~in~~~vvf~ IJ houses or shacks constructed on illegally occupied or sub-divided land, buying water of dubious qual- ity from private vendors at 1 0 to 20 tinnes the pr'ice per litre paid by mi(jdle or upper income groups in reside[ltial areas served by piped water. Similarly, it is no\ uncom- mon to find a heavy concentration of publicly financed health care services and facilities in large cities and yet the low income population in that city having little or no ac- cess to them." In such circumstances, how can the .health of the poor and under- served millions flourish? These are among the findings of a collabora- tive research programme which looked into the present and poten- tial role or small and intermediate urban centres in the cjevelopment process. The findings are pre~ sented by Jorge E. Hardqy and David Satterthwaite in their book ";oSmall and Intermediate Urban Centres" published by Hodder and Stoughton, London, in association with the lnternational .lnstitute for Environment and D€welopment. from Whom it may be ordered (price £15 sterling). . The book includes five regional studies~two in India and one each in . Supan, Argentina . and Nigeria"'-qf the way in which social., economiC and political forces mould and shape urban systems over time, .. and thus contribute to, or constrain, the ;o develbprnent of such sma.ll and medium~sized cities. In commentaries on · these sttJ(jies, . the two ,editors ask w~eth~rthe existing concentration of-; urban-base? activities in the largest city or . cities (usually the capital) truly servesnational, social and economic dev~lopment goals. They quote other studies shovving .. that the quality of health and 'edu- cation provided in the larger cities was "far superior to :that in the smaller cities.::. And they. conclude that "only through the U[ban sys- tem and its links with smaller settlements can governments increase. the proportion of, the population with access t'O h~altb care, education, postage and telephones, and other public services" . • 27