Longitudinal impact study · Western Cape, South Africa
Examining the causal impact of formal government housing on early childhood health and development.
South Africa’s housing subsidy programme is one of the largest of its kind worldwide — between 1994 and 2015, government housing and subsidies reached more than 4 million people, at a combined cost of roughly R300,000 per plot, connection and top structure.
Beyond precarious structure, informal housing is characterised by intersecting inadequacies in water supply, sanitation, drainage, energy and solid-waste collection — compounded by high neighbourhood density. This is not an environment conducive to good health, and the poor carry a disproportionate share of the resulting disease burden, which makes the question of housing’s impact on health a matter of social justice as much as public policy.
Existing evidence on the housing–health relationship is largely descriptive rather than causal, and typically confined to a single geographical area — limitations that make it hard to draw generalisable lessons. At a time of fiscal pressure, we expect this research to show substantial health and wellbeing benefits from formal housing: a strong motivation to sustain and expand the subsidy programme, sharpen emphasis on the aspects of housing shown to matter most for health, and identify what is preventing those health gains from being fully unlocked.
Clean water, improved sanitation and regular waste removal cut a child's exposure to faecal pathogens and parasites. Hygienic flooring — replacing bare dirt, a known reservoir for helminths and enteric infection — and clean energy replacing open flame both reduce infection risk and indoor air pollution, together lowering the chronic disease burden that undermines growth.
Financial security, reduced maternal stress and improved physical safety in a formal structure support early brain and cognitive development, alongside caregiver and household wellbeing.
Reduced pathogen exposure shapes a healthier gut microbiome — increasingly understood as central to child growth, since food alone won’t fix childhood stunting.
The study follows more than 700 households with a child under five, across 8 communities with active government housing projects in the Western Cape, from baseline through a midline wave to endline. Households are sampled from the Housing Subsidy System into one treatment and two comparison groups, using the timing of enrolment and delivery to build a credible counterfactual.
| Group | Description |
|---|---|
| AB — Treatment Informal → Formal | Current beneficiaries: living in informal housing at t1, in a formal house at t2 (24 months later) |
| AA — Comparison Informal → Informal | Future beneficiaries: registered but not yet housed, informal at both t1 and t2 |
| BB — Comparison Formal → Formal | Past beneficiaries: already living in formal housing at both t1 and t2 |
| Instrument | Captures |
|---|---|
| Household survey | Living conditions — sanitation, water, refuse and waste management; heating and cooking energy sources in winter and summer; socio-economic characteristics; demographics |
| Food safety & nutrition survey | Health and hygiene knowledge and practice; food storage, disposal and reheating practices; household dietary intake |
| Caregiver survey | Health/hygiene knowledge; child dietary diversity; caregiver-reported child health; child–parent conflict; child behaviour checklist |
| Adult survey | Self-reported illness and depression screening; sleep quality; perceived stress; anxiety; demographics and socio-economic characteristics |
| Fieldworker observation | Independent verification of self-reported water, sanitation and energy access, and observed behaviour |
| Environmental health measurements | In-house surface and kitchen-cloth swabs; air quality monitoring via 24-hour kitchen installations of PurpleAir and gravimetric devices |
| Personal health measurements | Anthropometrics; adult blood pressure and hypertension assessment; stool analysis |