Cities are growing fast—and so are slums. Over 1.1 billion people live in slums or slum-like conditions today, with this number expected to rise to 2 billion by 2030. Slum residents face overlapping risks: insecure housing, limited services, unsafe water, indoor air pollution from solid fuels, and barriers to healthcare—especially for women and children. UNSDUN-Habitat

Decades of research shows slums are not just “poor neighborhoods”; they are distinct environments where health burdens cluster and interact (infectious disease, maternal and newborn risks, injury, mental health, and chronic illness). Effective solutions therefore must be integrated—linking health, livelihoods, safe water and clean air, and social protection. The Lancet+1

Household air pollution alone (from wood/charcoal/coal) remains a major killer, tied to lower respiratory infections in children and excess mortality in adults—disproportionately affecting women and girls who cook and collect fuel. World Health Organization+1State of Global Air

Climate change is intensifying pressures on the urban poor—droughts, flooding, food insecurity, and power instability push rural families into cities and strain already-fragile services. In Zambia, an El Niño–driven drought was declared a national disaster in February 2024, damaging crops and hydropower and deepening urban vulnerability.

These dynamics mirror broader patterns across Africa and Asia—and underscore why slum health must be tackled with integrated programs that can flex with environmental and economic shocks. The Lancet

Our thesis: In slums, no challenge stands alone—so our programs shouldn’t either. The Circle of Care connects evidence-based interventions so families can move from survival to stability to self-reliance.

• Pediatric HIV Care → prevention + long-term care for children. (Results in Lusaka: high survival and no child born with HIV when families are linked to comprehensive supports.)
• Maternal & Newborn Health → digital early-warning tools + community workers to reduce preventable deaths; an approach well supported by urban-slum MCH evidence from India and other LMICs. This is work we are partnering with WONDER Health in India and will be rolling out in Zambia next.
• Mental Health → task-shifted, community-first access to reduce stigma and strengthen households - aligned with slum research showing mental health burdens often go untreated without proximate, low-barrier services.
• Microloans for Women → income + agency that spill over into nutrition, school retention, and health-seeking behavior - consistent with neighborhood-effects research in slums.
• Clean Water → household filtration reduces diarrheal disease and missed school/work in dense settlements.
• Clean Cooking → high-efficiency stoves that can burn a wide range of fuels aligned to slum residents’ needs reduce smoke exposure and fuel burden for caregivers, addressing a major, well-documented health risk.
• Malaria Prevention → nets + education remain among the most cost-effective life-saving tools in many urban/peri-urban African settings.
• Safe Park (Child Development) → structured play and learning to buffer toxic stress and support psychosocial health in high-adversity settings.

• Holistic by design - fits how risks cluster in slums
• Evidence-aligned - maps directly to the strongest urban-slum health findings – infectious diseases/maternal/child health, air/water, livelihoods).
• Locally led - community health workers and women entrepreneurs anchor trust and uptake
• Climate-aware - phased power/energy solutions; drought/flood responsive programming as seen in Zambia

Zambia has been our home for over two decades, serving not only as the base of our deepest work - with Matero families and urban communities - but also as an innovation lab for learning and adaptation. Research shows that slums worldwide tend to share more in common with each other than with the broader regions they inhabit - whether in Lusaka’s kombonis and compounds, Mumbai’s Dharavi, or Kibera in Nairobi. These environments consistently present overlapping risks: overcrowding, unreliable infrastructure, poor air and water quality, and limited access to health and economic opportunity. (See Friesen et al. 2020; Riley 2007.) This global commonality enables us to test integrated, contextual interventions in Zambia - linking pediatric HIV, maternal health, mental wellness, clean water, clean cooking, malaria prevention, and women’s micro-enterprise - and to scale the same model into Indian urban slums or future geographies. Each new location allows us to gently recalibrate delivery partners, languages, and referral systems while preserving the core of what we’ve learned works where risks converge.

Friesen, J., Friesen, V., Dietrich, I., & Pelz, P. F. (2020). Slums, space, and state of health—A link between settlement morphology and health data. International Journal of Environmental Research and Public Health, 17(6), 2022. https://doi.org/10.3390/ijerph17062022

Riley, L. W., Ko, A. I., Unger, A., & Reis, M. G. (2007). Slum health: Diseases of neglected populations. BMC International Health and Human Rights, 7(2). https://doi.org/10.1186/1472-698X-7-2

United Nations Human Settlements Programme (UN-Habitat). (2020). World cities report 2020: The value of sustainable urbanization. UN-Habitat. https://unhabitat.org/World-Cities-Report-2020

Ezeh, A., Oyebode, O., Satterthwaite, D., Chen, Y. F., Ndugwa, R., Sartori, J., Mberu, B., Melendez-Torres, G. J., Haregu, T., Watson, S. I., Caiaffa, W., Capon, A., & Lilford, R. J. (2017). The history, geography, and sociology of slums and the health problems of people who live in slums. The Lancet, 389(10068), 547–558. https://doi.org/10.1016/S0140-6736(16)31650-6

World Health Organization. (2018). Household air pollution and health. WHO. https://www.who.int/news-room/fact-sheets/detail/household-air-pollution-and-health

GBD 2017 Risk Factor Collaborators. (2018). Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. The Lancet, 392(10159), 1923–1994. https://doi.org/10.1016/S0140-6736(18)32225-6

Venkatesh, S., & Krishnan, S. (2020). Urban maternal and child health in low-income countries: Challenges and opportunities. BMC Pregnancy and Childbirth, 20, 345. https://doi.org/10.1186/s12884-020-03038-5