Population Reports' Q&As

Meeting the Urban Challenge

The Urban Poor

Why don't basic services needed for good health reach the urban poor?

Basic services needed for good health often do not reach the urban poor for several reasons:

• Municipal authorities do not recognize many informal settlements for political and administrative reasons, and thus these areas are not eligible for services. In some cases, slum areas are not classified as urban precisely because they lack services (120).
• The urban poor often settle on land not suitable for housing. Extending infrastructure such as roads, water mains, and sewer lines can be difficult because of rough terrain. Moreover, such neighborhoods often are developed haphazardly, without planning to allow space for infrastructure. In order to lay water or sewer pipes, the utility authorities often must remove or relocate many houses (120).
• Governments and donor agencies give low priority to providing such services as primary health care, basic education, family planning, water and sanitation, and nutrition, according to an analysis of 17 developing countries around the world (45). The UN and the World Bank agree that, on average, 20% of national budgets in developing countries and 20% of international aid should be allocated to extending these basic services to all people -both urban and rural. In the 17 countries studied, however, the average expenditure on these services was only 12% of total government spending-from 8% in Lebanon to 17% in Nepal. Similarly, in few instances did spending on basic services account for 20% or more of donor assistance (45).

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