A risk assessment framework for communicable diseases in informal settlements : a case study of COVID-19 in Melusi, City of Tshwane, South Africa

Abstract

Approximately one billion people live in slums or other conditions of informality that are particularly vulnerable to the outbreak of communicable diseases. The COVID-19 pandemic has raised concerns over the ability to manage such outbreaks in informal settlements. To plan and implement appropriate public health responses, risks must first be assessed. However, current risk assessment frameworks for communicable diseases either do not assess risk at the informal settlement scale or they consider only a small number of influencing factors. In this research, a risk assessment framework for informal settlements was developed, informed by a review of assessment frameworks and factors that facilitate the spread of the COVID-19 virus. Subsequently, the framework was implemented and evaluated for Melusi, an informal settlement in the city of Tshwane, South Africa. Results reveal that, in the context of COVID-19, the greatest exacerbators of vulnerability for the Melusi community were the dwelling structures; access to water and handwashing facilities and the dirty state of communal toilets. The community’s preparedness was strengthened by access to masks, a stable diet, healthcare and comorbidity management, despite the pandemic. Resilience was mainly due to households relying on multiple energy sources. The framework proved to have replication value but can be refined by collecting qualitative data from a wider group of participants and exploring novel ways for collecting quantitative data.