Maputo, Mozambique’s capital, is a fast-growing coastal city where most residents reside in informal or unplanned areas. Recent analyses estimate that between 75% and 80% of Maputo’s population lives in informal settlements, reflecting a pattern of spatial inequality and weak infrastructure provision. Academic and U.N.-Habitat assessments similarly note that at least 80% of the city is composed of informal settlements.

The municipality also struggles to meet the demand for basic infrastructure, including water supply, sewerage, solid waste management, energy, roads and communications. These deficits pose significant environmental and public health risks, particularly in peri-urban areas with self-built housing and unpaved roads. These conditions make Maputo a clear example of how urban health governance is inseparable from land use, infrastructure and local politics.

In such cities, health outcomes depend as much on municipal decisions about roads, sanitation and land tenure as they do on the formal health sector itself.

Informal Settlements, Infrastructure and Health Risk in Maputo

Studies of Maputo’s informal neighborhoods describe overcrowded, self-built housing, poor drainage and limited formal water and sanitation networks. Research on critical infrastructure in Maputo’s informal settlements shows that water pipes, stormwater drainage, sanitation, waste collection and public lighting are “almost nonexistent” in many areas. Some neighborhoods also still rely on unsafe sanitation and open defecation.

These conditions are explicitly linked to diseases such as diarrhea and cholera. Other studies on Maputo’s informal settlements document the links between socioeconomic status, settlement form and land consumption. They also highlight the exposure of low-income residents to flooding and other environmental risks.

This combination of dense informality and incomplete service coverage makes everyday environmental conditions a central driver of health outcomes. From a global health perspective, this means that interventions limited to clinics and hospitals will miss the root causes of disease burden. Effective urban health governance must therefore link health outcomes to improvements in water, sanitation, drainage, solid waste systems and safe housing in informal settlements.

City Government, Planning and Land

City-level politics are crucial in Maputo because the municipality controls or co-controls, key levers for planning, land management and basic services. Classic work on Maputo’s urban governance reveals that more than half of the city’s population lives in poverty. It also shows that most residents acquire land for housing through informal markets, reinforcing spatial and social inequality.

More recent analyses argue that informality is not an aberration but a dominant mode of urbanization in Maputo and that data on informal areas remain incomplete and outdated. This makes it harder for municipal authorities to plan and manage infrastructure in a way that reflects the realities of informal neighborhoods. U.N.-Habitat’s resilience work with the Municipality of Maputo, using the City Resilience Profiling Tool (CRPT), highlights institutional challenges related to data, coordination and long-term planning.

Recommendations of Actions for Resilience and Sustainability in Maputo focus on improving infrastructure, managing flood risk and strengthening local governance capacities. All of this underlines that urban health governance in Maputo is fundamentally tied to how the municipality regulates land, invests in infrastructure and engages with residents in informal neighborhoods.

Donors, Upgrading Programs and City-Level Investment

Maputo has been a focal point for large urban upgrading and infrastructure programs supported by international donors and development banks. A recent preprint and subsequent journal article on critical infrastructures in Maputo lists several major projects aimed at informal settlements, including:

• Maputo Urban Transformation Project
• Mozambique Urban Sanitation Project
• Maputo Metropolitan Area Urban Mobility Project
• Other neighborhood-level upgrading initiatives, such as the Chamanculo C and George Dimitrov projects

The World Bank’s Maputo Urban Transformation Project, approved in 2020, aims “to improve urban infrastructure and strengthen institutional capacity for sustainable urbanization in Maputo.” Components include informal settlement upgrading, city-center rehabilitation, sustainable urban growth in peripheral districts and institutional support. Progress reports indicate that hundreds of thousands of residents are benefiting from improved urban infrastructure, drainage, sanitation and roads in informal settlements.

The project also includes performance-based conditions to strengthen land tenure regularization, property tax reform and solid waste management. Earlier programs, such as ProMaputo, also supported by the World Bank and its partners, sought to modernize municipal administration, upgrade infrastructure and regularize land rights in selected neighborhoods. However, analyses note challenges including limited tenure regularization, relocation without secure alternatives and persistent deficits in basic services.

UN-Habitat’s Global Action Plan and Informal Settlement Health

At the global level, U.N.-Habitat has developed a Global Action Plan, titled “Accelerating for Transforming Informal Settlements and Slums by 2030,” which was launched in 2022. The plan is anchored in the Slums and Informal Settlements Network (SiSnet) and the Participatory Slum Upgrading Program (PSUP). It provides a framework for large-scale transformation of informal settlements through improvements in infrastructure, land tenure, community participation and policy reform.

U.N.-Habitat’s urban health work emphasizes that many determinants of health, including housing, transport, water, sanitation and public space, lie outside the health sector and within municipal mandates. It calls for integrated planning that positions health at the center of urban development efforts. Together, these initiatives position informal settlement upgrading and slum transformation as a core pathway for improving health outcomes in cities like Maputo.

They align local infrastructure projects with global frameworks for inclusive, climate-resilient and healthy urban development. This is exactly where urban health governance becomes a practical agenda: coordinating housing, infrastructure, participation and health objectives at the city scale.

Global Health Meets Local Politics

International health agencies are increasingly recognizing that city-level governance shapes health outcomes. The World Health Organization’s (WHO) initiative on Urban Governance for Health and Well-Being (2020–2028) works directly with mayors and city governments to strengthen participatory, multisectoral and multi-level governance, ensuring that health is at the center of decision-making. A companion WHO policy brief on governance and financing for urban health notes that governance structures and funding mechanisms are key challenges to achieving urban health goals.

It emphasizes the need for coordination across government levels and sectors. Maputo’s experience provides a clear, concrete example of these points:

• Health risks in informal settlements stem from gaps in infrastructure, such as water, sanitation, drainage and waste systems, as well as from land-use decisions.
• Major improvements rely on the authority and capacity of municipal governments, not just national ministries.
• Donor programs pass through city institutions and can either strengthen or bypass local systems.

For global health actors, this means that effective strategies must engage directly with municipal councils, planning departments, local utilities and community organizations, rather than focusing solely on national health ministries.

Conclusion

Maputo demonstrates that improving health in the Global South cannot rely on national policy alone. In cities where most residents live in informal settlements, health outcomes depend on urban health governance, which encompasses how city leaders plan, finance and implement infrastructure, as well as how they collaborate with donors and involve informal settlement residents in decision-making.

– Clara Garza

Clara is based in Los Angeles, CA, USA and focuses on Global Health and Politics for The Borgen Project.

Photo: Flickr