Africa is urbanising fast and is projected to have the largest urban population in the world by 2050. This put a spotlight on urban health in Africa as a global health and development priority. The World Cities Day 2024, observed each year on October 31, focused on the theme of Youth Leading Climate and Local Action for Cities. This year’s theme and World Cities Report highlighted the crucial role of youth, Africa’s biggest population group, in creating sustainable urban spaces, emphasising that healthier environments empower young people to lead impactful, transformative initiatives against climate change. The youth are considered essential advocates for climate and health action by challenging traditional governance structures and driving demand for responsive urban policies in Africa’s political landscape. These observations emphasise the fact that the path to healthier cities in Africa is inherently political. Unfortunately, the understanding of the political dynamics in African cities and advice on how to navigate them effectively for health advancement is still limited.
Political dynamics shaping urban governance and development in Africa
African cities operate within complex political landscapes and governance systems. Urban governance in African cities, such as Lagos, Kampala, and Nairobi, is shaped by a blend of local, national, and international forces. These cities operate under significant central government influence, impacting urban health, mobility, and sustainability policies. Colonial legacies, post-independence struggles, and clientelist politics create fragmented authority and competing agendas that complicate efforts for cohesive, multisectoral policies in health and development. Cities are often unprepared for rapid urbanisation. The realities of informal African urban spaces enhance vulnerabilities and often limit the urban poor’s agency and access to key livelihood resources and services.
Political and commercial forces and interests also strongly intersect to influence urban health in African cities. Take urban mobility, for example. While improved transportation systems could reduce air pollution and make healthcare services more accessible, such initiatives are frequently slowed by limited funding, fragmented governance structures, political competition and contestation by private transport operators. Climate resilience efforts face similar challenges. Policies designed to improve air quality and adapt to extreme weather events, for example, often take a back seat to short-term priorities driven by commercial or political interests.
Strategic actions to strengthen political thinking and action for urban health
With African cities expanding, challenges like traffic congestion, pollution, climate disasters and limited healthcare access demand a blend of technical and strategic political action to manage competing interests, ideological contestations and overlapping authority and mandates over jurisdictions. While policies promoting urban health often face resistance from profit-driven commercial interests, these forces also hold potential for collective action. Real estate developers, for example, may prioritise sprawling developments, which contradict health goals that favour liveable, walkable neighbourhoods. However, aligning commercial and public health objectives could lead to mutually beneficial outcomes. For instance, incentivising private developers to include parks and pedestrian-friendly spaces could support both economic and health goals.
To effectively manage the inherently political path to healthier African cities, two essential capacities should be developed: understanding the political landscape (political thinking) and navigating it effectively (political working). To develop the capabilities in thinking and working politically, the following strategies are recommended:
- Capacity enhancement in political (economy) analysis and action: equipping urban health practitioners with knowledge of applied political economy analysis and other sense-making techniques would help them understand power dynamics and leverage points within complex governance frameworks, driving health-positive change. Concerted interventions should emphasise real-life applications, like analysing governance structures, sectoral priorities, funding dependencies and barriers or facilitators to policy change in specific urban settings.
- Capacity development for collaborative governance and cross-sectoral leadership: Multisectoral interventions are the backbone of urban health advancement. However, coordination and governance of multisectoral efforts are inherently political. Leadership capacity enhancement in negotiation, coalition-building, and cross-sectoral collaboration fosters coordination within fragmented governance structures. Collaboration with research institutions is also important to provide evidence-based insights and prepare policymakers to design adaptable interventions that address the political and commercial determinants of health.
- Navigating the politics of policy design and implementation: Understanding policy development dynamics enables stakeholders to think beyond single-issue policies and instead craft “policy mixes” that integrate diverse tools to tackle complex urban health issues holistically. However, the adoption and implementation of coordination tools is also political and requires political working skills to overcome self-interest pressures and align various sectors toward health-focused goals. For example, policies that restrict car usage in congested urban areas may meet resistance from taxi operators and business owners, requiring policymakers to negotiate compromises or offer alternative incentives to gain their support.
- Adopting systems thinking to complement political approaches: Cities are complex adaptive systems. Complexity science and applied systems thinking also promote holistic approaches, integrating health and other development goals. These perspectives support multi-faceted policies rather than narrow, issue-specific solutions by encouraging a deeper understanding of how interconnected policies can impact each other. Systems thinking also fosters a continuous learning culture, emphasising adaptive learning, which catalyses practitioners to respond effectively to political shifts and evolving urban health challenges. Capacity enhancement to employ complexity-aware approaches such as participatory simulation modelling would greatly strengthen the political approaches.
About the Author
Dr. Aloysius Ssennyonjo (PhD, MD) is an interdisciplinary scholar whose work spans health, politics and development. He is keen on politics of urban health and political economy of multisectoral coordination in Sub-Saharan Africa. He is senior Lecturer in Department of Health Policy and Planning, Makerere University School of Public Health.
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