Surging amounts of waste are reported globally and especially in lower-income countries, with negative consequences for health and the environment. Increasing concern has been raised for the limited progress achieved in practice by diverse sets of policies and programmes. Waste management is a wicked problem characterised by multilayered interdependencies, complex social dynamics and webs of stakeholders. Interactions among these generate unpredictable outcomes that can be missed by decision makers through their understanding and framing of their context. This article aims to identify possible sources of persistent problems by focussing on what captures, shapes and limits the attention of stakeholders and decision-makers, drawing on the attention-based view from organisation theory. The theory describes the process through which issues and opportunities are noticed and how these are translated into actions, by focussing on the influencers at the individual, organisational and context scale. Views on issues and opportunities for waste management were collected in a series of fieldwork activities from 60 participants representing seven main types of stakeholders in the typical lower-middle income Kenyan city of Kisumu. Through a thematic analysis guided by the attention-based view, we identified patterns and misalignment of views, especially between government, community-based organisations and residents, which may contribute to persistent waste problems in Kisumu. Some point to detrimental waste handling practices, from separation to collection and treatment, as the main cause of issues. For others, these practices are due to a poor control of such practices and enforcement of the law. This study's major theoretical contribution is extending the application of attention theory to multi-stakeholder problems and to non-formalized organisations, namely residents and to the new field of waste management. This novel lens contributes a greater understanding of waste issues and their management in Africa that is relevant to policy and future research. By revealing the “wickedness” of the waste problem, we point to the need for a holistic and systems-based policy approach to limit further unintended consequences.

Background: Environmental improvement is a priority for urban sustainability and health and achieving it requires transformative change in cities. An approach to achieving such change is to bring together researchers, decision-makers, and public groups in the creation of research and use of scientific evidence. Methods: This article describes the development of a programme theory for Complex Urban Systems for Sustainability and Health (CUSSH), a four-year Wellcome-funded research collaboration which aims to improve capacity to guide transformational health and environmental changes in cities. Results: Drawing on ideas about complex systems, programme evaluation, and transdisciplinary learning, we describe how the programme is understood to “work” in terms of its anticipated processes and resulting changes. The programme theory describes a chain of outputs that ultimately leads to improvement in city sustainability and health (described in an ‘action model’), and the kinds of changes that we expect CUSSH should lead to in people, processes, policies, practices, and research (described in a ‘change model’). Conclusions: Our paper adds to a growing body of research on the process of developing a comprehensive understanding of a transdisciplinary, multiagency, multi-context programme. The programme theory was developed collaboratively over two years. It involved a participatory process to ensure that a broad range of perspectives were included, to contribute to shared understanding across a multidisciplinary team. Examining our approach allowed an appreciation of the benefits and challenges of developing a programme theory for a complex, transdisciplinary research collaboration. Benefits included the development of teamworking and shared understanding and the use of programme theory in guiding evaluation. Challenges included changing membership within a large group, reaching agreement on what the theory would be ‘about’, and the inherent unpredictability of complex initiatives.

Poor solid waste management in Kisumu, Kenya, contributes to adverse health, social, and environmental outcomes as a result of open burning, illegal dumping, and reliance on landfills. Taking Kisumu as a case study, we use behavioural systems mapping (BSM) for the purpose of understanding the role of behaviour in this complex problem. We qualitatively analysed transcripts from focus groups and interviews with 45 stakeholders in Kisumu to construct a BSM of the perceived actors, behaviours, and behavioural influences affecting waste management, as well as causal links. Influences were analysed using the capability, opportunity, and motivation model of behaviour (COM-B). The resulting BSM connects 24 behaviours by 12 different actors and 49 unique influences (30 related to opportunity, 16 to motivation, and 3 to capability). It reflects three sub-systems: policy-making, public waste management, and the policy–public interface. Six key feedback loops are described, which suggest that cycles of underfunding are interlinked with problematic practices around the build-up, handling, and segregation of waste and conflicting public and political views around responsibility. We demonstrate how the BSM method can be used with transcript data and provide steps that others can follow to inform the design of systemic behaviour change interventions. Further research to validate and adapt this approach may extend the learnings to other countries and health and sustainability challenges.

Background: Environmental improvement is a priority for urban sustainability and health and achieving it requires transformative change in cities. An approach to achieving such change is to bring together researchers, decision-makers, and public groups in the creation of research and use of scientific evidence. Methods: This article describes the development of a programme theory for Complex Urban Systems for Sustainability and Health (CUSSH), a four-year Wellcome-funded research collaboration which aims to improve capacity to guide transformational health and environmental changes in cities. Results: Drawing on ideas about complex systems, programme evaluation, and transdisciplinary learning, we describe how the programme is understood to “work” in terms of its anticipated processes and resulting changes. The programme theory describes a chain of outputs that ultimately leads to improvement in city sustainability and health (described in an ‘action model’), and the kinds of changes that we expect CUSSH should lead to in people, processes, policies, practices, and research (described in a ‘change model’). Conclusions: Our paper adds to a growing body of research on the process of developing a comprehensive understanding of a transdisciplinary, multiagency, multi-context programme. The programme theory was developed collaboratively over two years. It involved a participatory process to ensure that a broad range of perspectives were included, to contribute to shared understanding across a multidisciplinary team. Examining our approach allowed an appreciation of the benefits and challenges of developing a programme theory for a complex, transdisciplinary research collaboration. Benefits included the development of teamworking and shared understanding and the use of programme theory in guiding evaluation. Challenges included changing membership within a large group, reaching agreement on what the theory would be ‘about’, and the inherent unpredictability of complex initiatives.

Urbanization in most African countries has overstretched the available sanitation services, leading to unsafe disposal of faecal sludge especially among the urban poor. Recycling of faecal sludge into useful products is one of the ways to solve this problem as well as ensure environmental sustainability. This study assesses the awareness and attitudes of slum residents towards recycled faecal sludge products as well as barriers and opportunities for use. This was a qualitative study that used focus group discussions to collect data in three slums of Nairobi, namely; Korogocho, Viwandani, and Kibra. The community was aware of some of the recycled faecal sludge products; however, there were mixed attitudes towards the use of these products. The study identified religious, cultural factors, as well as infrastructural limitations hindering the use of products. More research, evaluation, and accreditation of FS products need to be done in efforts to ensure they meet safety standards and are of good quality. Radio spots in local radio stations and television programs as well as at the community levels using local leaders are good mechanisms of engaging the communities.

Background Solid Waste Management (SWM) in most developing countries, especially in Africa, faces several challenges that hinder proper management across the value chain. Kisumu City, the third-largest city in Kenya, faces numerous challenges in the waste collection and disposal sector. Kisumu generates an estimated 500 tons of waste daily, but only about 40% of it is collected and disposed of properly, leaving the rest to accumulate in open areas or water bodies. This poses significant health and environmental risks to residents and the ecosystem. Due to open dumping of waste, greenhouse gases (GHGs) are emitted into the air, causing air pollution and consequently contributing to climate change. Methodology We sought to identify the drivers of current solid waste management practices in five areas of Kisumu County (Nyalenda-A, Manyatta-B, Kaloleni, Manyatta - A, Migosi, and Nyalenda B). We used a cross-sectional study design and mixed-method approaches to conduct the research. About 400 household heads were interviewed, while 13 Key Informant Interviews and 10 Focus Group Discussions were conducted. Results About 8% of households practice proper SWM, and 35% of households receive waste collection services. Burning of waste is common at 77%. Level of education (P value = 0.11), income-generating activity (P value = 0.024), waste collection services P value = 0.001), and sex of the household (P value =0.09) had significant associations with proper solid waste management practices. Key challenges identified through the qualitative interviews include inadequate resources at the county level, a lack of awareness among the residents on the importance of proper waste management, poor policy implementation, and a poor attitude towards waste. Conclusion The county should have adequate budget allocation for SWM and the implementation of existing policies, for example, strict enforcement against illegal dumping, and littering by-laws, community sensitisation, as well as include women in decision-making in SWM.