This document is designed to support local authorities, leaders and policy-makers in cities and other urban settlements in identifying effective approaches and implementing recommended actions that enhance the prevention, preparedness and readiness for COVID-19 in urban settings, to ensure a robust response and eventual recovery. It covers factors unique to cities and urban settings, considerations in urban preparedness, key areas of focus and preparing for future emergencies.
Preparedness in cities and other urban settlements is critical for effective national, regional, and global responses to COVID-19. These settings face unique dynamics that affect preparedness – they serve as travel hubs, have a higher risk of disease spread due to high population densities, and many have extensive public transport networks. Diverse subpopulations have different sociocultural needs and contain vulnerable groups. Some live in crowded and substandard housing, lack access to safe water, sanitation, and hygiene facilities, and those in informal settlements are also more often unemployed or dependent on informal economies. Cities also have centres for advanced medical care and are critical to broader health systems. Local authorities have governance and policy-making responsibilities and play an important role throughout the emergency management cycle – from preparedness and readiness to response to and eventual recovery from COVID-19.
To be effective, any public health measure must be implementable and designed in a way that will promote a willingness to comply. Urban authorities should:
- Adopt a coordinated multisectoral, whole-of-government and whole-of-society approach;
- Promote coordination and coherence in measures across governance levels;
- Identify existing hazards and vulnerabilities;
- Identify and equitably protect vulnerable subpopulations;
- Consider diverse social and cultural interactions with health issues, norms, and perceptions;
- Consider the extent of reliance on the informal sector or economy;
- Consider the most appropriate means of communication of information;
- Ensure continued provision of essential services;
- Ensure that health facilities are prepared for COVID-19 and identify and mobilize additional resources;
- Ensure adequate housing, reduce risk of homelessness and anticipate outward migration and mobility;
- Ensure that due consideration is given to maintaining good mental wellbeing;
- Ensure that measures are rooted in a robust evidence-base as far as possible and account for the resulting impact on lives and livelihoods.
In addition to the COVID-19 strategic preparedness and response plan (SPRP) and the COVID-19 strategy update, there are four key areas that local authorities of cities and urban settlements should focus on in ensuring preparedness for a robust response to COVID-19:
- Coordinated local plans in preparation for effective responses to health risks and impacts;
- Risk and crisis communication and community engagement that encourages compliance with measures;
- Contextually appropriate approaches to public health measures, especially physical distancing, hand hygiene, and respiratory etiquette; and
- Access to health care services for COVID-19 and the continuation of essential services.
During recovery or between epidemic peaks, cities and other urban settlements should refer to the interim guidance on adjusting public health and social measures in the context of COVID-19, in ensuring that the stepping down of measures is in keeping with the considerations described, is balanced against the risk of disease resurgence, and ensures that any escalation of spread can be rapidly detected. Urgent actions for COVID-19 must set the stage for sustainable capacity development for concurrent or future health emergencies. Documentation, learning, and sharing of COVID-19 experiences will help to inform and build better preparedness for reducing the risks and impacts of future health emergencies.