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Planning healthy communities in the towns of Uganda
PLANNING HEALTHY COMMUNITIES IN THE TOWNS OF UGANDA By B. E. C. H O P W O O D, M.R.C.S., L.R.C.P., D.I'.H., D.I.H.
Senior M.O., Labour Department, Government of Uganda. UNTIL very recently the planning of urban areas in Uganda has been confined~ to satisfying the needs of external people, chiefly those of European and Indian stock. There has been a marked tendency to reproduce in the urban areas the type of living conditions to which the former have been accustomed. The European areas of most townships, however small, have been graciously laid out with plenty of open space, tree-lined avenues and pleasant gardens. Similarly, the people from India have reproduced their own conditions as nearly as possible. During this period of development African occupation of urban areas has. been more or less confined to one-roomed quarters, housing those who work in domestic service or minor industries, together with a number of undisturbed rural dwellers who have inadvertently become engulfed in the urban boundaries. Like most social problems the increase of African occupation within township boundaries crept along almost unnoticed. It was only when it became necessary to provide more space for the expanding external population, which is mostly confined to residence in urban areas, that the problem was realised. When this happened it was found that the Africans within the urban areas, had increased considerably and that apart from the original dwellers, a squatter population had grown up, living both inside the towns and around their boundaries. These increases in population were naturally more intense in the larger towns. One of the attempts to solve this problem was the creation of a Government Department whose primary function has been to provide shelter for those displaced from their rural-type homes in the towns and also to provide for the increasing numbers of new inhabitants. These functions were of such pressing importance that there has been no opportunity for social investigatiorL and the needs of these new communities have not yet been investigated. URBAN
INHABITANTS
There is, at the present time, no complete knowledge of the exact composition of the population and indeed, to find this out exactly would be timeconsuming and expensive. It is possible, however, to make an intelligent guess at its composition and on this basis it is suggested that the population may be classified in the following way : (a) Original dwellers of township areas. 374
P L A N N I N G H E A L T H Y C O M M U N I T I E S IN "rilE TOWNS OF U G A N D A
375
(b) Visitors. (c) Temporary workers. (d) Permanent workers. (e) True town dwellers. The size of each group naturally varies from town to town, but it is probable that in most towns groups (a) and (c) are the largest. At the moment the majority of the African urban population falls into one or other of these groups. The groups do not remain constant, there is always movement from one to another. Those included in the first group might also be included in any of the others. Having classified the population, it becomes necessary to decide how and why the people come to the towns and what their future movements are likely to be. In other words, what motivates the lives of the people concerned ? MOTIVATION
(a) The Original Dwellers of Townships Many of these people have become urban dwellers by force of circumstances when the town boundaries were established. Many of them still remain in the town hut still attempt to live an undisturbed rural form of family existence. Quite clearly they will not be able to continue in this way and as far as they are concerned, change of some sort or another is inevitable. They may resettle and if they do, the likelihood is that they will do so in the peri-urban area around the township. They may, in the course of time and owing to the reduction in the resources of the land which they hold, be compelled to become temporary or permanent workers. Ultimately, they may well become true town dwellers.
(b) The Visitors These are the people who find themselves in the urban areas largely out of curiosity. They are usually young people, unmarried and who are free therefore to come and go as they wish. They may stay short or long periods and the longer they stay the more likely they are to move into the temporary worker group or eventually the permanent worker group. Nevertheless, most of these people have some stake in the land elsewhere and while that state of affairs continues, they are likely to return. If they stay longer than they expect they may form a delinquent society which might well move from one urban area to another and become a social nuisance.
(c) The Temporary Workers This group is probably the largest in the urban population, particularly in the larger towns. Most of these people have homes elsewhere; their reason for coming to the town is to work in order to obtain enough money to satisfy some desired object. They are what is called "target workers". The target or the object may be anything from a bicycle to a bride price or the provision o f
376
PUBLIC
HEALTH
VOL.
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NOS.
10..11
a permanent roof to the house or perhaps to collect sufficient money for school fees. It may often be to collect enough money to pay poll taxes. The majority of this group are without their families. They have been unaccustomed to provide for themselves and when they reach the towns, for the first time in their lives, they find that they have to pay for shelter and to buy food. The budgeting which is necessary under these circumstances, if their target is to be achieved, is not inconsiderable and the consequence is that many of them find that it takes longer to achieve their target than they anticipated. This class of worker is likely, therefore, to stay in the town any time from six months to two years. One of the social evils under these circumstances is that the temporary worker, after a relatively prolonged absence from his family, finds himself deprived of his wifely comforts and he frequently forms a liaison with another woman. This may be purely temporary in nature or he may regard her as a second wife. In either case, he is obviously in difficulties and in the end he may be forced by financial circumstances to abandon either his original wife or the one he has acquired in the town. There is also a danger that this class of man may seek the solution to his difficulties by indulging in crime. The movement of the temporary worker into the permanent worker class is more difficult unless he has already severed the ties that he had in his tribal area before he came and unless he is unmarried. In the latter event he is quite likely to become a permanent worker.
(d) The Permanent Workers In the past most of the permanent workers came from areas surrounding the towns and indeed many of them still do. There has been, however, an increasing necessity by employers, particularly by Government, that this class of worker should be subject to transfer from one area to another. The effect of this change is greater for those who have a dwelling and an interest in the land near some urban area and this is mostly the case. Many of the people in this group, although they are permanent workers, are still able to rely on other resources than the money that they get from their earnings. Frequently they are only accompanied by their families for relatively short periods because of maintaining the family "shambas". Ultimately the majority of this class when they finish their working life will not continue to live in the urban area but will return to their original homes. (e) The True Town Dwellers At the moment there are very few people who qualifiy for inclusion in this class. The true town dweller has probably come either from the first group who were originally in the town or else from the permanent worker group. He has no interest in land elsewhere and he is therefore content to live in the town for the rest of his life. If he has evolved from the permanent worker group then in addition he has most probably become completely de-tribalised.
P L A N N I N G H E A L T H Y C O M M U N I T I E S IN T H E TOWNS OF U G A N D A NEEDS
OF
THE
TOWN
377
DWELLERS
General It is evident that the African population in urban areas is made up from different social groups and consequently their social circumstances will differ very widely. They come from different tribes, their customs will vary and so will their ordinary day-to-day living habits. One of the matters of the greatest importance is to decide whether to perpetuate the tribal habits and customs or whether a new set of customs can be created for the town dweller. If tribal customs are destroyed social discipline is destroyed with them and it is essential that if this happens other social conventions, equally compelling, must be created to replace them.
(a) The Original Town Dwellers Sooner or later members of this group will have to move or be removed from the township areas or their way of life will have to become altered. Unless resettlement of these people is carefully controlled they will naturally tend to move beyond the township boundaries and create a septic fringe. In order to prevent this happening, resettlement terms must be equitable or even generous where compulsion is impracticable. The land to which people are resettled must be at least as extensive and as fertile as that which has been left behind. Assistance should be given in the building of new homes and the planting of crops. Resettlement should not be to an area too far removed from the town otherwise the tribal and local affinities will be lost. For the members of this group who are already workingqn the township areas or who have good prospects of being able to earn sufficient money to maintain a reasonable standard of living, some form of monetary compensation might be adequate provided always there is suitable alternative accommodation within the township. Monetary compensation should perhaps be limited to those who are in employment and who agree to lodge in the housing estates, where these are available, otherwise the only form of compensation that should be offered should be in the nature of resettlement.
(b) The Visitors The man with sufficient resources of his own who comes to visit relatives or friends creates no problem, nor does the relatively wealthy businessman. It is the man without resources, with little education and with few family ties that creates the difficulty. There is a very narrow margin between this type of town dweller and the temporary worker, the difference between the two depends upon the intention of the individual. The aimless visitor easily resorts to crime and delinquency. If he is unable to find shelter with relatives or friends his resources are exhausted very rapidly. It would seem that one solution to this problem is the provision of carefully controlled lodging-houses which would provide free shelter and cheap food.
378
PUBLIC
I-IEAI.TH
VOL.
LXXIII NOS.
10-11
It is clear, however, that the length of time that anyone can stay in such a place would have to be limited and at the end of a limited period the visitor should either graduate to the temporary worker class or be encouraged to go back to his home.
(c) The Temporary Workers The needs of the temporary worker are cheap shelter, food and work. It is unusual for this class of person to have very much money when he first arrives. Unless he immediately obtains work which also provides accommodation and food or unless he is able to live with relatives or friends, he is in obvious difficulties until he receives wages. The lodging-house type of accommodation already referred to would seem to be the answer to the initial problem of the temporary worker but he should not be allowed to continue living in a lodginghouse after he has received his first wages. He may stay as long as two years in the town. During this time as far as housing is concerned he needs the cheapest possible form of healthy shelter on a rented basis.
(d) The Permanent Workers The use of the term "permanent" is a relative one in this connection. It is unusual for the permanent worker to wish to build for himself or to own a house in the urban area. He will require a house for long periods where he can live with his family who, although they will probably not live all the time in the town, will have to be accommodated occasionally. At the present time and probably for some time to come, this class of worker will have his home elsewhere and the house in which he lives in the town will not be a home as far as he is concerned. Nevertheless, the house will have to provide more than simple shelter and be adapted to the needs of the varying standards of living of this group.
(e) True Town Dwellers The true town dweller will have no other home. He may be one of the original inhabitants or he may have evolved from the permanent worker group. He will very often wish to own his own house and his house will need the attributes of a home in which he can bring up his family. DISCUSSION
It is a relatively simple matter to define an urban population and to see what are the needs of each group. It is when it comes to satisfying the needs that the difficulties are encountered. In Uganda there is no stable urban population in any of the towns. If it were possible to maintain a stable population of true town dwellers the solution to the problem would be relatively easy. This state of affairs, however, will not be achieved in Uganda for a very long time. Although the country's population is increasing at a rate of between
PLANNING HEALTHY COMMUNITIES IN THE TOWNS OF UGANDA
379
1 and 2 ~ p.a. densities of population are still relatively low. Industrialisation has been born in Uganda within the last 20 years but Uganda will always remain primarily an agricultural country and there will never be the same type of industrial revolution which occurred in Europe. The composition of the urban population, therefore, is likely to remain very much the same for many years so that it is necessary to accept the population circumstances as they are and to plan accordingly. For healthy communities to be evolved in the towns, the needs of all the various groups must be satisfied. These needs have been briefly mentioned and as far as the original town dweller and the true town dwellers are concerned, the need is for healthy homes whilst for the visitor and the temporary worker cheap, healthy shelter is needed. The permanent worker's needs may be any gradation of accommodation from cheap, healthy shelter to healthy homes. How are the needs of all these groups to be met? It is surely a problem to be solved by team-work like most matters of social medicine. The medical officer of health, the administrative officer, the economist, the social worker, the edueationist, the town planner, the engineer, the builder, the plumber, the butcher, the baker, the candlestick maker, and, perhaps most important of all, the people themselves. It is one of the greatest problems in any community to get all these people to work as a team. In Uganda it is more than usually difficult because the actual individuals who make up the team are constantly changing. Under these circumstances working in a vacuum is all too common but no member of the team can do his job by ignoring other members of it. The particular function of the medical officer of health is to ensure that well-established and simple rules of health are not forgotten. In the first place he is concerned with the prevention of disease, still an urgent matter in Uganda. What sort of living conditions are needed ? In the first place there must be sufficient space in any dwelling to provide enough accommodation for those who intend to live in it. It must be weatherproof; it must have ventilation and it is important that this ventilation should be so designed that people will not be forced to block it up during a violent storm or because the house is made draughty as a result. There must be windows in the house to let in the sunlight to remove the dark corners so that the rooms can be properly cleaned. There must be water, preferably laid on to the house but at least reasonably accessible. The floors and walls must be smooth and impervious so that there is no harbourage for vermin. There must be provision for the disposal of refuse from the household in a proper manner. There must be satisfactory sanitation; the only satisfactory form of sanitation in urban areas, where the population is likely to be dense, is some form of water-borne sanitation. There must be adequate and proper storage for food and space and facilities to prepare and cook it. Such a dwelling can be calculated
380
PUBLIC
HEALTH
VOL.
LXXIII
NOS,
10-1|
at least not to contribute to the spread of disease and although it might be considered basically to be satisfactory it is still not a home. Positive health is the maintenance of a community healthy in body and contented in mind. The implications of this definition are all-embracing but here it is necessary to keep to the relationship of housing towards the aim of achieving positive health. Professor J. M. Mackintosh has said: "The essential purpose of housing is to provide as far as structure and equipment can do so, within defined limits of costs in capital and maintenance, the conditions of comfort, health and enjoyment that are needful for the making of a home and the nurture of the family". There are two very important factors in the above statement. One is the reference to the limiting factor of cost in capital and maintenance and the other is the reference to a home. The essential purpose of housing is limited by defined limits in cost and in maintenance and here we have the greatest stumbling block of all to normal development. The majority of Africans in Uganda fall into three groups. (a) Occupier of land which produces a house and subsistence but insufficient income for other needs. (b) Occupier of land which does not provide sufficient subsistence. (c) The man who has no land at all. None of these will be able to build at all unless they happen to achieve a job which provides them with a high income. How can the needs of the people be met when the majority of them have therefore insufficient resources to provide their own housing in urban areas ? One thing is fairly obvious, and that is that it is important that those who are able to maintain themselves satisfactorily in rural surroundings should be encouraged to stay where they are. The present situation is met by the provision of houses for rent in housing estates which have been built by Government. These estates are heavily subsidised. Nevertheless, these estates so far only provide for those whose homes are elsewhere. This fact has been recognised and consequently areas have been set aside where people may build their own houses and where loans are available and this is, as yet, the only real provision for those who are going to become the true town dwellers. It would seem illogical to provide financial assistance to temporary dwellers when there is a need for setting up permanent urban communities and there seems no reason why there should not be an equal subsidy to those who, in the end, will provide the work force for the urban areas. Finally, it is important to know what is meant by the term " h o m e " and what has to be considered in order to achieve the transition of a house into a home. If one accepts the four pillars of health as the family, the house, food, and work, there can be no home without a family. From the previous classification of the likely population of urban areas
P L A N N I N G H E A L T H Y C O M M U N I T I E S IN THE TOWNS OF U G A N D A
381
on this basis, it will not be possible to provide homes for those only working temporarily in the towns nor for those permanent workers who do not have their families with them. It should, however, be possible to provide homes for those of the other three groups that have previously been mentioned, namely, the original town dwellers, some of the permanent workers and the true town dwellers. To modern ideas the function of a house is to provide for the family as an organic unit of society so that it can enjoy a happy life. Planning in Uganda so far has been in the hands of people from outside the country. These people have applied the experience and knowledge that has been gained over hundreds of years in other continents to the benefit of the local people. Sometimes mistakes have been made, sometimes too much emphasis has been placed on introducing foreign methods which, in the event, have proved to be difficult to adapt to local needs. Particularly as far as housing is concerned, it is very necessary for the African people to tell the planners what it is that turns a house into a home, what they expect a house to provide them with. For it is only in this way that homes for the Africans in Uganda can be produced.
Senior M.O., Labour Department, Government of Uganda. UNTIL very recently the planning of urban areas in Uganda has been confined~ to satisfying the needs of external people, chiefly those of European and Indian stock. There has been a marked tendency to reproduce in the urban areas the type of living conditions to which the former have been accustomed. The European areas of most townships, however small, have been graciously laid out with plenty of open space, tree-lined avenues and pleasant gardens. Similarly, the people from India have reproduced their own conditions as nearly as possible. During this period of development African occupation of urban areas has. been more or less confined to one-roomed quarters, housing those who work in domestic service or minor industries, together with a number of undisturbed rural dwellers who have inadvertently become engulfed in the urban boundaries. Like most social problems the increase of African occupation within township boundaries crept along almost unnoticed. It was only when it became necessary to provide more space for the expanding external population, which is mostly confined to residence in urban areas, that the problem was realised. When this happened it was found that the Africans within the urban areas, had increased considerably and that apart from the original dwellers, a squatter population had grown up, living both inside the towns and around their boundaries. These increases in population were naturally more intense in the larger towns. One of the attempts to solve this problem was the creation of a Government Department whose primary function has been to provide shelter for those displaced from their rural-type homes in the towns and also to provide for the increasing numbers of new inhabitants. These functions were of such pressing importance that there has been no opportunity for social investigatiorL and the needs of these new communities have not yet been investigated. URBAN
INHABITANTS
There is, at the present time, no complete knowledge of the exact composition of the population and indeed, to find this out exactly would be timeconsuming and expensive. It is possible, however, to make an intelligent guess at its composition and on this basis it is suggested that the population may be classified in the following way : (a) Original dwellers of township areas. 374
P L A N N I N G H E A L T H Y C O M M U N I T I E S IN "rilE TOWNS OF U G A N D A
375
(b) Visitors. (c) Temporary workers. (d) Permanent workers. (e) True town dwellers. The size of each group naturally varies from town to town, but it is probable that in most towns groups (a) and (c) are the largest. At the moment the majority of the African urban population falls into one or other of these groups. The groups do not remain constant, there is always movement from one to another. Those included in the first group might also be included in any of the others. Having classified the population, it becomes necessary to decide how and why the people come to the towns and what their future movements are likely to be. In other words, what motivates the lives of the people concerned ? MOTIVATION
(a) The Original Dwellers of Townships Many of these people have become urban dwellers by force of circumstances when the town boundaries were established. Many of them still remain in the town hut still attempt to live an undisturbed rural form of family existence. Quite clearly they will not be able to continue in this way and as far as they are concerned, change of some sort or another is inevitable. They may resettle and if they do, the likelihood is that they will do so in the peri-urban area around the township. They may, in the course of time and owing to the reduction in the resources of the land which they hold, be compelled to become temporary or permanent workers. Ultimately, they may well become true town dwellers.
(b) The Visitors These are the people who find themselves in the urban areas largely out of curiosity. They are usually young people, unmarried and who are free therefore to come and go as they wish. They may stay short or long periods and the longer they stay the more likely they are to move into the temporary worker group or eventually the permanent worker group. Nevertheless, most of these people have some stake in the land elsewhere and while that state of affairs continues, they are likely to return. If they stay longer than they expect they may form a delinquent society which might well move from one urban area to another and become a social nuisance.
(c) The Temporary Workers This group is probably the largest in the urban population, particularly in the larger towns. Most of these people have homes elsewhere; their reason for coming to the town is to work in order to obtain enough money to satisfy some desired object. They are what is called "target workers". The target or the object may be anything from a bicycle to a bride price or the provision o f
376
PUBLIC
HEALTH
VOL.
LXXIII
NOS.
10..11
a permanent roof to the house or perhaps to collect sufficient money for school fees. It may often be to collect enough money to pay poll taxes. The majority of this group are without their families. They have been unaccustomed to provide for themselves and when they reach the towns, for the first time in their lives, they find that they have to pay for shelter and to buy food. The budgeting which is necessary under these circumstances, if their target is to be achieved, is not inconsiderable and the consequence is that many of them find that it takes longer to achieve their target than they anticipated. This class of worker is likely, therefore, to stay in the town any time from six months to two years. One of the social evils under these circumstances is that the temporary worker, after a relatively prolonged absence from his family, finds himself deprived of his wifely comforts and he frequently forms a liaison with another woman. This may be purely temporary in nature or he may regard her as a second wife. In either case, he is obviously in difficulties and in the end he may be forced by financial circumstances to abandon either his original wife or the one he has acquired in the town. There is also a danger that this class of man may seek the solution to his difficulties by indulging in crime. The movement of the temporary worker into the permanent worker class is more difficult unless he has already severed the ties that he had in his tribal area before he came and unless he is unmarried. In the latter event he is quite likely to become a permanent worker.
(d) The Permanent Workers In the past most of the permanent workers came from areas surrounding the towns and indeed many of them still do. There has been, however, an increasing necessity by employers, particularly by Government, that this class of worker should be subject to transfer from one area to another. The effect of this change is greater for those who have a dwelling and an interest in the land near some urban area and this is mostly the case. Many of the people in this group, although they are permanent workers, are still able to rely on other resources than the money that they get from their earnings. Frequently they are only accompanied by their families for relatively short periods because of maintaining the family "shambas". Ultimately the majority of this class when they finish their working life will not continue to live in the urban area but will return to their original homes. (e) The True Town Dwellers At the moment there are very few people who qualifiy for inclusion in this class. The true town dweller has probably come either from the first group who were originally in the town or else from the permanent worker group. He has no interest in land elsewhere and he is therefore content to live in the town for the rest of his life. If he has evolved from the permanent worker group then in addition he has most probably become completely de-tribalised.
P L A N N I N G H E A L T H Y C O M M U N I T I E S IN T H E TOWNS OF U G A N D A NEEDS
OF
THE
TOWN
377
DWELLERS
General It is evident that the African population in urban areas is made up from different social groups and consequently their social circumstances will differ very widely. They come from different tribes, their customs will vary and so will their ordinary day-to-day living habits. One of the matters of the greatest importance is to decide whether to perpetuate the tribal habits and customs or whether a new set of customs can be created for the town dweller. If tribal customs are destroyed social discipline is destroyed with them and it is essential that if this happens other social conventions, equally compelling, must be created to replace them.
(a) The Original Town Dwellers Sooner or later members of this group will have to move or be removed from the township areas or their way of life will have to become altered. Unless resettlement of these people is carefully controlled they will naturally tend to move beyond the township boundaries and create a septic fringe. In order to prevent this happening, resettlement terms must be equitable or even generous where compulsion is impracticable. The land to which people are resettled must be at least as extensive and as fertile as that which has been left behind. Assistance should be given in the building of new homes and the planting of crops. Resettlement should not be to an area too far removed from the town otherwise the tribal and local affinities will be lost. For the members of this group who are already workingqn the township areas or who have good prospects of being able to earn sufficient money to maintain a reasonable standard of living, some form of monetary compensation might be adequate provided always there is suitable alternative accommodation within the township. Monetary compensation should perhaps be limited to those who are in employment and who agree to lodge in the housing estates, where these are available, otherwise the only form of compensation that should be offered should be in the nature of resettlement.
(b) The Visitors The man with sufficient resources of his own who comes to visit relatives or friends creates no problem, nor does the relatively wealthy businessman. It is the man without resources, with little education and with few family ties that creates the difficulty. There is a very narrow margin between this type of town dweller and the temporary worker, the difference between the two depends upon the intention of the individual. The aimless visitor easily resorts to crime and delinquency. If he is unable to find shelter with relatives or friends his resources are exhausted very rapidly. It would seem that one solution to this problem is the provision of carefully controlled lodging-houses which would provide free shelter and cheap food.
378
PUBLIC
I-IEAI.TH
VOL.
LXXIII NOS.
10-11
It is clear, however, that the length of time that anyone can stay in such a place would have to be limited and at the end of a limited period the visitor should either graduate to the temporary worker class or be encouraged to go back to his home.
(c) The Temporary Workers The needs of the temporary worker are cheap shelter, food and work. It is unusual for this class of person to have very much money when he first arrives. Unless he immediately obtains work which also provides accommodation and food or unless he is able to live with relatives or friends, he is in obvious difficulties until he receives wages. The lodging-house type of accommodation already referred to would seem to be the answer to the initial problem of the temporary worker but he should not be allowed to continue living in a lodginghouse after he has received his first wages. He may stay as long as two years in the town. During this time as far as housing is concerned he needs the cheapest possible form of healthy shelter on a rented basis.
(d) The Permanent Workers The use of the term "permanent" is a relative one in this connection. It is unusual for the permanent worker to wish to build for himself or to own a house in the urban area. He will require a house for long periods where he can live with his family who, although they will probably not live all the time in the town, will have to be accommodated occasionally. At the present time and probably for some time to come, this class of worker will have his home elsewhere and the house in which he lives in the town will not be a home as far as he is concerned. Nevertheless, the house will have to provide more than simple shelter and be adapted to the needs of the varying standards of living of this group.
(e) True Town Dwellers The true town dweller will have no other home. He may be one of the original inhabitants or he may have evolved from the permanent worker group. He will very often wish to own his own house and his house will need the attributes of a home in which he can bring up his family. DISCUSSION
It is a relatively simple matter to define an urban population and to see what are the needs of each group. It is when it comes to satisfying the needs that the difficulties are encountered. In Uganda there is no stable urban population in any of the towns. If it were possible to maintain a stable population of true town dwellers the solution to the problem would be relatively easy. This state of affairs, however, will not be achieved in Uganda for a very long time. Although the country's population is increasing at a rate of between
PLANNING HEALTHY COMMUNITIES IN THE TOWNS OF UGANDA
379
1 and 2 ~ p.a. densities of population are still relatively low. Industrialisation has been born in Uganda within the last 20 years but Uganda will always remain primarily an agricultural country and there will never be the same type of industrial revolution which occurred in Europe. The composition of the urban population, therefore, is likely to remain very much the same for many years so that it is necessary to accept the population circumstances as they are and to plan accordingly. For healthy communities to be evolved in the towns, the needs of all the various groups must be satisfied. These needs have been briefly mentioned and as far as the original town dweller and the true town dwellers are concerned, the need is for healthy homes whilst for the visitor and the temporary worker cheap, healthy shelter is needed. The permanent worker's needs may be any gradation of accommodation from cheap, healthy shelter to healthy homes. How are the needs of all these groups to be met? It is surely a problem to be solved by team-work like most matters of social medicine. The medical officer of health, the administrative officer, the economist, the social worker, the edueationist, the town planner, the engineer, the builder, the plumber, the butcher, the baker, the candlestick maker, and, perhaps most important of all, the people themselves. It is one of the greatest problems in any community to get all these people to work as a team. In Uganda it is more than usually difficult because the actual individuals who make up the team are constantly changing. Under these circumstances working in a vacuum is all too common but no member of the team can do his job by ignoring other members of it. The particular function of the medical officer of health is to ensure that well-established and simple rules of health are not forgotten. In the first place he is concerned with the prevention of disease, still an urgent matter in Uganda. What sort of living conditions are needed ? In the first place there must be sufficient space in any dwelling to provide enough accommodation for those who intend to live in it. It must be weatherproof; it must have ventilation and it is important that this ventilation should be so designed that people will not be forced to block it up during a violent storm or because the house is made draughty as a result. There must be windows in the house to let in the sunlight to remove the dark corners so that the rooms can be properly cleaned. There must be water, preferably laid on to the house but at least reasonably accessible. The floors and walls must be smooth and impervious so that there is no harbourage for vermin. There must be provision for the disposal of refuse from the household in a proper manner. There must be satisfactory sanitation; the only satisfactory form of sanitation in urban areas, where the population is likely to be dense, is some form of water-borne sanitation. There must be adequate and proper storage for food and space and facilities to prepare and cook it. Such a dwelling can be calculated
380
PUBLIC
HEALTH
VOL.
LXXIII
NOS,
10-1|
at least not to contribute to the spread of disease and although it might be considered basically to be satisfactory it is still not a home. Positive health is the maintenance of a community healthy in body and contented in mind. The implications of this definition are all-embracing but here it is necessary to keep to the relationship of housing towards the aim of achieving positive health. Professor J. M. Mackintosh has said: "The essential purpose of housing is to provide as far as structure and equipment can do so, within defined limits of costs in capital and maintenance, the conditions of comfort, health and enjoyment that are needful for the making of a home and the nurture of the family". There are two very important factors in the above statement. One is the reference to the limiting factor of cost in capital and maintenance and the other is the reference to a home. The essential purpose of housing is limited by defined limits in cost and in maintenance and here we have the greatest stumbling block of all to normal development. The majority of Africans in Uganda fall into three groups. (a) Occupier of land which produces a house and subsistence but insufficient income for other needs. (b) Occupier of land which does not provide sufficient subsistence. (c) The man who has no land at all. None of these will be able to build at all unless they happen to achieve a job which provides them with a high income. How can the needs of the people be met when the majority of them have therefore insufficient resources to provide their own housing in urban areas ? One thing is fairly obvious, and that is that it is important that those who are able to maintain themselves satisfactorily in rural surroundings should be encouraged to stay where they are. The present situation is met by the provision of houses for rent in housing estates which have been built by Government. These estates are heavily subsidised. Nevertheless, these estates so far only provide for those whose homes are elsewhere. This fact has been recognised and consequently areas have been set aside where people may build their own houses and where loans are available and this is, as yet, the only real provision for those who are going to become the true town dwellers. It would seem illogical to provide financial assistance to temporary dwellers when there is a need for setting up permanent urban communities and there seems no reason why there should not be an equal subsidy to those who, in the end, will provide the work force for the urban areas. Finally, it is important to know what is meant by the term " h o m e " and what has to be considered in order to achieve the transition of a house into a home. If one accepts the four pillars of health as the family, the house, food, and work, there can be no home without a family. From the previous classification of the likely population of urban areas
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on this basis, it will not be possible to provide homes for those only working temporarily in the towns nor for those permanent workers who do not have their families with them. It should, however, be possible to provide homes for those of the other three groups that have previously been mentioned, namely, the original town dwellers, some of the permanent workers and the true town dwellers. To modern ideas the function of a house is to provide for the family as an organic unit of society so that it can enjoy a happy life. Planning in Uganda so far has been in the hands of people from outside the country. These people have applied the experience and knowledge that has been gained over hundreds of years in other continents to the benefit of the local people. Sometimes mistakes have been made, sometimes too much emphasis has been placed on introducing foreign methods which, in the event, have proved to be difficult to adapt to local needs. Particularly as far as housing is concerned, it is very necessary for the African people to tell the planners what it is that turns a house into a home, what they expect a house to provide them with. For it is only in this way that homes for the Africans in Uganda can be produced.