 Now I would like to invite Dr. Michelle Katsudi to join us. Michelle is a veterinarian at the University of Nairobi and was an intern here at Illry in the animal and human health program. And she would like to tell us today about her work in Nairobi. Thank you so much, Michelle. Thank you. Thank you, Lian, for that introduction. So, yes. So my name is Michelle Katsudi and I will be presenting on work, on a study that I did with Dishon Maloy and Eric Favre on integrating ecosystem and public health into urban planning, a case study of Nairobi City. So I'll begin with the definition of urbanization. This is the population shift from rural to urban areas. In other words, it is the process through which cities are formed. And here we can see the numbers of urban population worldwide from the year 1980, which was 39%. And in 2015, it rose to 54%. And it is postulated that by 2050, the number will rise to 66%. And just where are these urban residents going to reside? A research shows that one in three urban donors live in slums or informal settlements. As you can see in this image, it shows a wealthy neighborhood next to informal settlements. And we can see the disparity and inequality that directly affects the health of urban residents. So what can we use to measure the health of urban residents? These are some of the determinants that can be measured. We have physical housing, health services, food systems, air quality, among others. And after looking at these and doing an in-depth research on urban health, we discovered that there are gaps in urban health. And these include weak linkage between urban planning, urban health, and urban biodiversity. There is minimal interaction and coordinated efforts amongst the coolers. And then there are weak integrated surveillance systems to monitor and survey these determinants of health. And in an attempt to address these gaps, we decided to develop an interdisciplinary project on urban ecosystem health, incorporating urban planning, ecology, and human health. So we decided to use Nairobi as the location for this study because it is an ideal depiction of a rapidly urbanizing city. 60% of its residents live in informal settlements and it has high infectious and non-communicable disease burden. In the image on the right, we can see an interesting relationship between a country's gross national product and the mortality caused by infectious disease and non-communicable disease. We can see that as the GNP increases, mortality caused by non-communicable disease increases, while that caused by infectious disease decreases. We also have here an article from the conversation about how Nairobi is rapidly losing its green spaces, which could lead to increased disease incidents. So the approach that we used, we did an in-depth literature review on urban health. And then I developed a theory of change which helped guide and map the work. Then the next step was to identify relevant stakeholders through internet searches, then contacting the stakeholders that was through emails and phone calls, and then have key informant interviews to generate data on the different systems. And in these interviews, we use the snowballing approach to identify other key partners. So 30 institutions were identified and 18 responded so far and 12 meetings have been done with representatives from each sector. We divided the four, we divided the institutions into four categories that is research institutions, urban planning, public health, ecosystem health. And as we can see in the graph, in the charts below there, that is how they were divided. The data analysis plan involved data collection, transcription of the meetings, a thematic analysis to draw out major things from the interviews. And then since this is an ongoing work, we plan to generate and validate hypothesis with government planning authorities and then test these hypotheses in the field and in the lab. So this is a theory, the theory of change that I came up with it states the problem which is lack of relationship between urban planning, ecosystem health and public health. Then the main goal which is to institutionalize operational linkage not just because we are aware that there are linkages that exist but we want to make sure that they are operational. So our long-term goals include creating new and strengthening existing collaborations and partnerships amongst the stakeholders, empowering Kenyan researchers and planning authorities on the created collaborations and also strengthening urban ecosystem, surveillance systems and ultimately contributes to sustainable human settlement planning. Our short-term goals, I'll just mention a few because of time, identification of stakeholders which we already did, another like stakeholder capacity building which we plan to do and setting up surveillance systems. These are some of the assumptions that we have as we do the work. For example, that the partnerships that are formed will be sustainable and that the planning authorities and policy makers are willing to adapt research into their decisions. And then some of the indicators that we have, the surveillance frameworks that are created and evidence of synergies between the stakeholders. So after doing transcription and thematic analysis, these are some of the themes that we're emerging. We have weak coordination, 75% of the respondents stated that there are clear individual roles and existing partnerships between the urban health sectors, but there are ill-defined linkages between the sectors. One of the respondents stated that, and I quote, water is far from health, which essentially means that they believe that water supply has no relation to health outcomes. Another theme was competing priorities. The respondents stated that they're competing priorities that might be caused by sometimes in some cases, some stakeholders are given tokenistic roles in projects, while others are given disproportionate influence on planning decisions. Then there's the theme of minimal operationalization. The respondents state that frameworks for urban development and policy exist, but there is poor implementation. This can be caused by, for example, changes in governance, which cause changes in priorities. And then it leads to a delay in implementation. There's also a little accountability caused by these limited platforms through which the implementers can be held accountable for their inaction. And then funding, one of the respondents stated that they have a challenge with financing, which causes a delay in implementation. Well, another stated that stakeholders are too dependent on international organizations for external funding instead of taking the initiative for urban development. Then we also have weak research policy interface. Most of the respondents agree that research is incorporated into urban planning decisions, but there is also that comes with weak implementation, which causes a challenge. There are also unintegrated surveillance systems. So currently we only have three urban demographic surveillance systems in Sub-Taharan Africa. One of them is in Ethiopia, the other in Burkina Faso, and we have one right here in Nairobi. The Nairobi urban demographic surveillance system has been operational for the last 18 years and is run in two slums in Nairobi and this collects information on main demographic events, health, and socioeconomic outcomes. Another concern was COVID-19, where the respondents were concerned about how we can sustain the responses to COVID, to other outbreaks and how we can plan our cities for outbreak response. So this is just another illustration of the different responses from the different sectors. On the y-axis, we have the respondents in percentage. On the x-axis, we have the different sectors and the bars represent the different themes. So we can see that weak coordination and research incorporation was mentioned by respondents from all the different sectors. And interestingly, the research sector did not mention a challenge with implementation. And then we can also see that only the research sector and the ecosystem health sectors have active urban surveillance systems. So our conclusions for this work is that there are weak linkages existing within the urban health sectors. There are challenges with implementation and operationalization of policies and frameworks. And there is need to form new and strengthen existing urban health surveillance systems. Our recommendation would be to adopt a holistic approach to urban health and establish central coordination for the stakeholders, the different stakeholders that is vets, ecologists and scientists and urban planners also to be on the same page and have clearer goals. Our main goals, as I mentioned in the theory of change are in line with the Sustainable Development Goals. We have SDG 17 to promote implementation and partnership, SDG 11 to mix cities and human settlements, inclusive, safe, resilient and sustainable and SDG 3 to ensure healthy lives and promote well-being for all. So our future work involves having a series of meetings and workshop for further stakeholder engagement and also for capacity building. And through these meetings, we can have focus group discussions where we'll generate and validate hypotheses and then we'll hold a major stakeholder meeting where we can build a fundable research program. I'd like to acknowledge the founders of this work, UKRI and GCRF and everyone else who made this work possible and supported it. Thank you. Thank you so much, Michelle. That was absolutely fascinating talk and I'm really sorry that due to our time constraints, most of your questions will be followed up in the chat if that's okay. But I'm sure I'd like to just ask direct one thing to you. I'm sure that's that you might have seen missing stakeholders in our mentee session. So do you want to reflect on the participants of this meeting and anyone you see are missing? Well, in relation to the work that I'm doing, I didn't notice any urban health. Any from the, sorry, urban planning sector. So maybe you can incorporate them because we are trying to have a plan for sustainable future, sustainable urban planning for future health. So I think to include them in this one health approach would be important. Thank you. Yeah, I think this was the first time I had really considered this and it was a real eye opener. So thank you so much for your talk, say.