1. 1 The Effects of Population Growth on the Achievement of the MDG on Child Mortality in Urban Sub- Saharan Africa Memorandum Submitted to the UK APPG-PDRH By APHRC, Nairobi, Kenya Dr Jean-Christophe Fotso, Dr Alex Ezeh Dr Nyovani Madise, and Mr James Ciera London, UK, June 5, 2006

2. 2 Is SSA on Target to Meeting the MDG? Current and projected trends in under-five mortality in SSA Source: UNICEF (data online) -13% -67%

3. 3 Why Should we Focus on Urban Areas?  Urban explosion amidst declining economies 15% in 1950; 32% in 1990; 54% in 2030 Urban population growth of 4.7% in 1980-2000 Decline in per capita GDP by 0.8%  Increasing proportion of urban dwellers living below the poverty line in slums and shantytowns Unsafe drinking water and poor environmental sanitation Limited access to health facilities  Increased susceptibility of slum children to various health problems

4. 4 The Evidence

5. 5 Implications  Failing to target the urban poor: Pulling down of national average of health indicators Move countries away from achieving the MDG on child mortality  Newly assembled evidence indicates: Gradual shift in the locus of poverty from rural to urban areas Higher levels of morbidity and mortality among urban poor children than among their rural counterparts (Nairobi, Kenya)

6. 6 Case Study in Nairobi, Kenya

7. 7 Poor-rich fertility gaps Source: Kenya DHS 2003

8. 8 Conclusion  SSA is not on target to meet the MDG on child mortality  Arouse attention and commitment on urban population growth in SSA and the associated growing urban poverty  Commitment of APHRC to: Improving the well-being of populations through policy-relevant research on population & health Key area of work: Clarifying the changing linkages between urbanization, poverty and health in SSA

9. 9 Thank you