Informal settlements lock-in: Drivers, impacts, and pathways to sustainable urban development - A thematic review

This paper examines the complex governance landscape of public health service delivery in the informal urban settlements of Dhaka, Bangladesh, through the application of Hybrid Governance and Urban Political Ecology (UPE) frameworks. Rapid urbanization and insufficient state capacity have led to the development of informal settlements, where conventional governance structures are absent. In this context, hybrid governance systems emerge, which are characterized by collaborations and conflicts among formal authorities, non-state and informal actors, and local community members. In-depth empirical data were drawn from multi-method qualitative research applying community-based participatory research (CBPR) approaches, conducted between 2021 and 2023, in two informal urban settlements in Dhaka, Bangladesh. This paper introduces a "Multi-layered Hybrid Governance" (MHG) framework that explains the complex governance arrangements of public health service delivery in informal urban settlements. The MHG framework features the fragile yet resilient nature of collaborations between formal authorities (state-level governing bodies), formal governance actors (elected local government representatives) and their informal representatives (community leaders, local elites), private service providers (including NGOs), and community members, revealing how public health services are negotiated and legitimized within these informal contexts. The findings suggest that hybrid governance is a form of community resilience that can enhance service delivery in the absence of effective state intervention. However, it can also reinforce existing inequalities and introduce new challenges to residents, especially to those without political connection or strong social networks. This paper urges policymakers and researchers to look beyond conventional health governance models and recognize the limitations of the existing systems. By presenting the MHG framework as an analytical tool for learning health systems from the perspectives of those on the margins, we advocate for more inclusive, resilient governance approaches for promoting justice and ensuring sustainability within fragmented urban health systems.

Latife Tekin’s Berji Kristin: Tales from the Garbage Hills marks a pioneering intervention by bringing the peripheral slum settlements to the forefront of urban discourse. Establishing a distinctive subgenre of “shantytown fiction” situated in a milieu of garbage, the text reorients representations towards literary urban studies. This article examines Berji Kristin through the framework of Mike Davis’s “slum ecology” to uncover the mechanisms of “necropolitics” (Achille Mbembe) as the underpinning necropower structure. Engaging with waste critique to explore the symbolic ramifications of waste in perpetuating urban exclusion of informal settlers, and by employing Timothy Morton’s notion of “hyperobjects,” the study investigates the agential materiality of waste and its lethal entanglement with the precarious lives of the squatters in the novel. Through close reading, the article shows how waste operates as an amorphous entity of the social “Othering” by examining the intersection of occupation, location, and the socio-political accumulation of “waste.”

Toxoplasma gondii infection poses a substantial global health burden, yet transmission pathways and population susceptibility in urban informal settlements remain poorly characterised, particularly for women of childbearing age. We analysed archived samples from a cross-sectional serosurvey of 728 children and adolescents aged 4-18 years living in a marginalised urban community in Salvador, Brazil, to characterise exposure patterns and identify demographic, socioeconomic, behavioural, household, and environmental factors associated with seropositivity and to assess spatial heterogeneity in exposure risk. Overall seroprevalence was 49%, increasing with age and higher in males than females; Bayesian serocatalytic models estimated sex-specific forces of infection of 0.078 for males and 0.050 for females, with approximately half of female participants still susceptible upon reaching childbearing age, highlighting the risk of congenital toxoplasmosis. In regression analyses, seropositivity was associated with male sex, lower household income, cat ownership, and residence at lower elevation, greater distance from the main road, and reported contact with sewer water. Notably, most seropositive participants (77.3%) did not live in households with cats. Geostatistical modelling demonstrated fine-scale spatial heterogeneity, with clustered hotspots exceeding 50-60% predicted prevalence. Adjustment for measured covariates attenuated but did not eliminate spatial clustering, indicating residual fine-scale spatial structure consistent with unmeasured environmental processes operating beyond individual households, alongside additional unstructured variation that may reflect household-level or peridomestic differences not captured by the measured covariates. Together, these findings provide evidence consistent with an important role for household and peridomestic environmental exposure pathways in T. gondii transmission in informal settlements, extending beyond households with domestic cats and shaped by social marginalisation and environmental vulnerability.

Invisible nexus of antimicrobial resistance and urban informal settlements.

Tech facilitated intimate partner violence is increasingly embedded in everyday Ugandan digital life, including phone confiscation, SIM card control, WhatsApp monitoring, coerced "proof," mobile money coercion, and reputational threats. This article examines digital coercive control as household governance and analyses how survivors and frontline supporters produce evidence under threat, focusing on the practical work of assembling "evidence packages" that may include screenshots, voice notes, timelines, and witnesses. Drawing on comparative qualitative research across an informal settlement in Kampala, a regional town, and a rural district with strong kin governance, the analysis shows how digital control reorganizes access to communication and money, how evidence making is shaped by safety calculations and stigma, and how institutions unevenly validate or dismiss digital traces. The article contributes to the sociology of intimate partner violence by showing that evidentiary credibility is socially distributed: the same digital trace may be read as proof, gossip, provocation, shame, or insufficient evidence depending on the survivor's social position, available intermediaries, and institutional venue. The article advances a low-resource approach to safer evidence intake across policing, health care, and community mediation, emphasizing patterned coercive control and survivor safety.

The COVID-19 lockdown restrictions, while necessary to curb the spread of the virus, also led to the increase in gender-based violence (GBV) in many countries, including South Africa. Despite numerous studies on GBV, the voices of local community members, as key informants with situated knowledge, have largely been excluded. This study therefore explored community members’ accounts of GBV during the COVID-19 lockdowns. Participants included men and women from an informal settlement in Johannesburg South. Three focus group discussions, each consisting of 12–13 participants, were undertaken to collect the data. The study used structural violence theory as well as Ubuntu feminism as a framing tool. Data were analysed using thematic analysis. The findings point to increased intra-familial violence, a deepening culture of silence around violence, escalating neglect within health and protection services, and the stifling of community activism. Participants also recounted feelings of helplessness in their efforts to mitigate GBV, alongside expressions of solidarity with survivors. Overall, the findings suggest that the COVID-19 lockdown restrictions unintentionally magnified existing drivers of GBV. We argue that future crisis responses –whether public health, social, or economic – must integrate violence prevention and protection mechanisms, ensuring that measures intended to safeguard populations do not simultaneously intensify gendered harm.

In resource-constrained settings like South Africa’s informal settlements, adolescent boys and young men (ABYM) often navigate complex socio-economic and cultural pressures that shape their Sexual and Reproductive Health (SRH) behaviors, choices, and identities significantly. This study explored how ABYM perceived and experienced changes in their SRH behaviors and related psychosocial outcomes after participating in a Combination Social Protection programme (CSP) that integrated structural, interpersonal, economic, and behavioral components in resource-constrained settings of Gauteng, South Africa. The study adopted an exploratory qualitative design. A sample of 12 ABYM was purposively selected from NGOs in Gauteng that implemented the CSP. Data were collected through semi-structured qualitative interviews and analyzed using Creswell and Creswell’s model of thematic data analysis. The findings indicate that the participants’ sexual attitudes, behaviors, and perceptions of gender norms were shifted positively following their attendance of the CSP intervention. The CSP programme’s apparent success in impacting sexual behaviors and gender norms among ABYM offers a critical entry point for rethinking adolescent programming at the policy level. However, the geographic limitation of the study underscores the need for future comparative studies across diverse settings using robust longitudinal Randomized Control Trial designs.

SUMMARYBACKGROUNDEffective post-exposure management is essential to control drug-resistant TB (DR-TB). However, little is known about how health care workers (HCWs) make decisions on post-exposure management in resource-constrained settings.METHODSWe conducted a qualitative study using semi-structured interviews with 22 HCWs in the Western Cape, South Africa. Data were analysed thematically and interpreted using the Situated Clinical Decision-Making Framework (SCDMF) to explore how contextual conditions, knowledge, and clinical cues influence judgement and action in practice.RESULTSFour interrelated themes were identified: crowded living conditions in informal settlements; stigma and non-disclosure of TB status; incomplete or delayed clinical information; and limited formal training on DR-TB post-exposure management. These factors constrained HCWs’ access to reliable social and clinical cues, limited their ability to assess exposure risk, and made consistent application of guidelines challenging. In response, HCWs relied on experiential knowledge, clinical intuition, and peer consultation to manage uncertainty. Real-world conditions frequently diverged from the SCDMF’s assumptions of enabling contexts, timely information, and accessible professional knowledge.CONCLUSIONHCWs’ decision-making for DR-TB post-exposure management is shaped by systemic constraints that necessitate adaptive but informal practices. Strengthening diagnostic turnaround times, formal training, and context-sensitive strategies to address stigma is critical to support consistent, evidence-based post-exposure DR-TB care.

Growing evidence identifies linkages between drought and flooding and poorer sexual health outcomes, yet adolescents and youth are understudied in this research. We aimed to explore the lived experiences of adolescents and youth regarding the associations between drought/flooding, resource insecurity, and sexual health in Mathare and Kisumu, Kenya. We conducted a multi-method qualitative study in Mathare, an urban informal settlement in Nairobi, and Kisumu and adjacent fishing communities, with a purposive sample of youth aged 16-24 years. We conducted SenseMaker individual interviews with the web-based tool, followed by group-based digital storytelling workshops. We conducted framework thematic analysis guided by the resource insecurity framework. SenseMaker participants included n=20 youth (Kisumu: n=10 women; Mathare: n=5 women and n=5 men), followed by four group-based digital storytelling workshops with 33 youth (Kisumu: n=9 women; Mathare: n=8 mothers, n=8 men; n=8 women). There were 42 unique participants. Participant narratives reflected the following themes: (1) drought and flooding exacerbate multiple resource insecurities (food, water, sanitation, menstruation); (2) increased resource insecurity-related transactional sex; (3) drought, flooding, and resource insecurities increase risks of sexual and gender-based violence; and (4) youth recommend structural- and community-level strategies for promoting sexual health. Findings from a sample of youth in two climate-affected Kenyan settings identify complex pathways from drought and flooding to sexual health, particularly through resource insecurity, transactional sex, and sexual and gender-based violence. Findings can guide the integration of extreme weather and sexual health programming with youth to integrate economic empowerment and sexual and gender-based violence reduction to advance equity and rights.

Diarrheal diseases remain a leading cause of under-five mortality globally, yet large-scale water, sanitation, and hygiene (WASH) interventions have shown limited effects on childhood diarrhea and growth, partly because foodborne transmission has been overlooked. In low-income urban settings, complementary foods for young children are often stored for several hours under unsafe conditions, increasing the risk of fecal contamination. This randomized controlled trial evaluated whether a low-cost wire-mesh food cabinet (“meatsafe”), paired with one-time behavior-change communication (BCC), could reduce microbial contamination and diarrhea among children aged 6–24 months in the Korail informal settlement of Dhaka, Bangladesh. A total of 290 households were randomly assigned 1:1 to receive a meatsafe plus food-hygiene handouts or no intervention. Over five biweekly post-intervention visits, we collected stored complementary food samples (≥4 h) for Escherichia coli testing and recorded 7-day caregiver-reported diarrhea. The primary outcome was the prevalence of high-level contamination (≥100 CFU E. coli/g). Prevalence ratios (PRs) were estimated using population-averaged modified Poisson regression adjusted for storage conditions. Across 1,545 food samples, contamination declined in both arms—from 49.6% to 25.2% in controls and 39.0% to 18.6% in the intervention arm—but the intervention had no effect on high-level contamination (adjusted PR = 0.83; 95% CI: 0.55–1.26) or caregiver-reported diarrhea (PR = 0.56; 95% CI: 0.24–1.31). Storing food for more than eight hours remained strongly associated with contamination (aPR = 1.49; 95% CI: 1.20–1.86). Although meatsafe adoption was high (88% at first visit, 99% at last), recall of general hygiene messages was limited. Providing a meatsafe with minimal BCC did not reduce food contamination or child diarrhea, despite excellent uptake. The findings underscore the limits of simple, passive technologies in resource-constrained settings and suggest that future strategies should integrate affordable storage innovations with more intensive and sustained hygiene promotion.Trial registrationClinicalTrials.gov, NCT07332078. Registered 12 January 2026 (retrospectively registered); https://clinicaltrials.gov/study/NCT07332078.

ABSTRACT Climate-induced mobility in African cities is often portrayed as a rational adaptive response to environmental stress, a framing that obscures the gendered, spatial, and institutional forces shaping who moves, who stays, and who is left behind. Using feminist and participatory methods, this study examines women’s experiences in four climate-vulnerable informal settlements in Accra: Agbogbloshie, Chorkor, Glefe, and Odawna. Insights from gender-segregated focus group discussions and key informant interviews reveal that adaptation emerges not from formal planning but through everyday labour, including carrying children through floodwaters, elevating belongings, and maintaining networks of mutual care. Despite being central to household and community resilience, women’s work remains largely invisible to planners. Mobility is seldom protective, while immobility shaped by poverty, caregiving roles, and insecure tenure can heighten risk. Institutional responses remain fragmented and gender-blind, highlighting the need for urban climate governance grounded in feminist ethics and local knowledge.

Food hygiene is a critical but underemphasized link in fecal-oral disease transmission in dense informal settlements. A mesh-walled meatsafe, designed to exclude insects, animals, and young children while allowing ventilation, was distributed in a randomized controlled trial in Korail, Dhaka. Despite near-universal use (87.7-99.2% of intervention households storing cooked food across five spot-check rounds), the trial detected no reductions in food contamination or child diarrhoea. This qualitative substudy investigated what technological, psychosocial, and contextual factors limited the meatsafe's protective potential despite high observed use. Guided by the Integrated Behavioral Model for Water, Sanitation, and Hygiene (IBM-WASH), we conducted 16 in-depth interviews with primary caregivers, purposively sampled to capture variation in meatsafe condition, maintenance, and food contamination profiles, and triangulated findings against spot-check records. Transcripts were thematically coded across IBM-WASH domains. Barriers preventing correct device use (fidelity barriers) included a steam-spoilage belief leading caregivers to cool food uncovered before meatsafe placement, rexine liner warping reinforcing cooling delays, and cumulative hardware friction from frame instability, latch weakness, and size constraints. Barriers that operated outside the scope of the intervention (beyond-fidelity barriers) included energy scarcity enforcing batch cooking with extended storage, monsoon flooding contaminating cooking spaces, seasonal displacement disrupting routines, and contested childcare authority limiting maternal protective behavior. The uncovered cooling period was invisible to spot-check monitoring yet represented the highest-risk contamination window. Near-universal meatsafe use without contamination reductions is explained by a behavioral gap invisible to spot-check monitoring: households stored food only after an uncovered cooling period. The meatsafe addressed only one F-diagram pathway; other fecal-oral routes remained uncontrolled. Sustainable reduction of foodborne enteric disease requires co-designed hardware addressing the full causal pathway, behavior change communication directly confronting the steam-spoilage belief, and concurrent structural investment in energy access, drainage, and pest control.

ABSTRACT Megacities face mounting tensions between development imperatives and climate resilience, particularly affecting marginalized communities in informal settlements. This study examines how residents of informal settlements in Lagos, Nigeria, navigate climate impacts while confronting exclusion from formal adaptation planning. Drawing on ethnographic fieldwork across 20 settlements, this research introduces two key concepts: adaptation infrastructures – socio-technical systems that systematically organize practices, knowledge and materials to manage climate impacts while fulfilling resource needs – and adaptation livelihoods – economic activities addressing climate needs while providing income. Residents construct sophisticated systems including bridging networks, land stabilization through waste processing, and water distribution serving both settlements and the broader city. However, Lagos State's vision of becoming ‘The Next Dubai’ creates misalignment between formal planning and community capacities. When settlements are demolished under climate protection rhetoric, adaptation infrastructures are dismantled, dispersing residents without their networks and practices. These findings challenge deficit-based vulnerability models and suggest pathways for equitable adaptation that recognize existing community capacities rather than displacing them through development-oriented interventions. While everyday adaptations have been widely documented, this paper is among the first to analyse them across urban scales, identifying empirical examples of adaptation livelihoods and infrastructures operating simultaneously at the individual or household, settlement and city scales.

ABSTRACT In this article, we analyze the processes of multiple bordering experienced by families of irregularized Venezuelans in South America. We distinguish three interwoven bordering processes: social boundaries, international geopolitical borders, and interior frontiers. We adopted an ethnographic approach, with six months of fieldwork with Venezuelan families living in tomas – informal settlements – in northern Chile. We show that Venezuelan migration, particularly after 2017, constitutes a survival migration involving social groups suffering hunger and health problems and even death, resulting from lack of access to food and medical care. Material and symbolic resources that shape this social displacement condition the degree of friction migrants experience with borders across South America. In the tomas, although conditions of precariousness vary, urban segregation and rejecting affects toward migrants impact them in a widespread manner. We conclude that the category of “irregularised migrant” is only one stage within a broader process of social selection that produces bordered subjects.

This paper examines the interactions between planning systems, legal frameworks and green infrastructure (GI) assets in informal settlements by analysing the case of Amirieh, Iran. It seeks to address gaps in the literature by examining how, despite the importance of promoting sustainable development in informal urban contexts, planning dynamics may contribute to the degradation of GI in rapidly urbanising areas. Using a qualitative research approach, the paper demonstrates how laws intended to protect green areas can actually accelerate their erosion in an environment of perverse incentives and weak institutions. It highlights how the neglect of public environmental benefits in favour of capital development can exacerbate existing social inequalities in an informal settlement. • This paper illustrates how formal legal plans and the Acts designed to conserve Agricultural and garden lands, jointly accelerate the loss of Amirieh’s gardens to housing, through formalisation degrading GI. • Advances a push–pull explanatory framework: political-institutional “pull” (short tenures, visible-project bias, entrepreneurial municipal finance, legal loopholes) versus environmental/financial “push” (drought, water scarcity, rising costs, falling yields) driving GI loss. • Fills a documented lacuna in urban greening scholarship by analysing how formal frameworks undermine GI specifically in an informal-settlement context, extending Global South evidence. • Empirically substantiated through 37 interviews, structured field observation, and multi-scalar plan review with thematic analysis and triangulation. • Identifies socio-environmental consequences, loss of ecosystem services, livelihoods and cultural identity, and pathways to environmental injustice/green gentrification, worsening heat, flooding and air-quality risks.

The societal impact of research: Lessons from adoption of green energy practices in informal settlements in Eldoret, Kenya

• Auto-construction accounts for the majority of housing built in Lima. • Develops storylines to illustrate energy and housing trajectories. • Vulnerability is present at every stage of the auto-construction process. • Progress does not mean escaping energy poverty and achieving dignified housing. This paper explores the interconnections between housing and energy as intersecting social challenges that generate complex and evolving states of vulnerability in informal settlements. Addressing a critical gap in the literature, particularly in data-scarce contexts of the Global South, the research challenges the dominant assumption that, given sufficient time and urban consolidation, people can move out of energy and housing poverty. Drawing on focus groups, oral histories, surveys, and participatory video-making in two settlements in Lima, Peru, the research employs a narrative approach to present three composite life stories. These narratives reveal how prolonged processes of neighbourhood consolidation (re)produce cycles of deprivation, that are shaped by spatial and material configurations, social relations, thermal comfort, and everyday energy risks. The narrative method ensures contextual depth while enhancing the accessibility and resonance of findings for policymakers, practitioners, and affected communities. The results underscore the need to look beyond infrastructure-focused and economic interventions and advocate for the need to support the different stages of auto-construction while safeguarding inhabitants’ autonomy. We also argue that the factors examined are relevant across informal settlements globally, offering a comparative lens to address housing and energy vulnerabilities amid climate and compounded crises.

Assessing the validity and reliability of geotracking devices in urban settings of Nairobi, Kenya.

Whose land builds the city? Spatial politics and power dynamics in negotiating space for infrastructure during informal settlement regularization in Mbarali, Tanzania