Revitalising Informal Settlements and their Environments (RISE): Assessing health, social, and environmental outcomes following water-sensitive revitalisation of informal settlements in Indonesia and Fiji

Twenty-four informal settlements have been randomised to participate in the trial (12 located in Makassar, Indonesia; 12 located in Suva, Fiji). Twelve settlements will be intervention sites while the remaining sites will be control sites. Intervention and control sites will be equally distributed between the two main study locations. Prior to the start of the trial, a baseline survey will be conducted to collect baseline demographics and health data in all settlements. The intervention arm will involve delivery and construction of water-sensitive revitalisation infrastructure. These interventions will be site-specific but may include the installation of latrines and septic tanks, use of subsurface wetlands for sewage treatment, use of biofilters, building-scale rainwater harvesting, and installing street-scale drainage and storm water treatment facilities; improving roads and access; and connection to municipal sewer systems. Design and architectural teams from Monash University will personalize all infrastructure to each settlement site. Government bodies at each site (City Government of Makassar in Indonesia and Department of Housing, under the Ministry of Local Government, Housing and the Environment in Fiji) will be kept informed of all aspects of construction and monitoring. The original study protocol was for the first two years of the study will consist of protocol and intervention design, site selection, community and individual enrolment, community engagement, and community co-design of intervention. Construction at intervention sites was planned to commence towards the end of the third year of the study and was to be completed by the end of year 4; leaving a monitoring period post-construction of 2 years (for a total study length of 5 years). However, the study was delayed by over 2 years due to the COVID-19 pandemic and has also had additional building delays so will take approximately 9 years to complete. After the trial concludes, the twelve control settlements will receive the above water-sensitive infrastructure. All settlement sites will receive information about the rationale of the project and its focus on water and sanitation management. Once enrolled, and for the full duration of the trial, all communities will be visited by field workers at least every 6 months (this includes before and during the build of the intervention as well as after the installation of the intervention is completed). At that time, a range of health and wellbeing data will be collected using questionnaires. Field workers will collect fecal samples from children under 5 every 3 to 6 months and blood samples from children under 5 every 6 to 12 months. Participant recruitment is ongoing as enrolment is offered to all new residents coming into the RISE settlements. Final enrolment will cease at the end of the project. The changes to sampling frequency occurred after COVID lockdowns (2020/2021) which incurred significant project delays, necessitating protocol changes. At the start of 2022, when these changes were made, RISE had recruited 7741 participants.

A two-arm parallel-cluster randomised controlled trial (RCT) design with stratified randomisation by number of children under 5 years, flood risk and site (i.e. settlements) characteristics. Twenty-four informal settlements randomised to participate in the trial (12 located in Makassar, Indonesia; 12 located in Suva, Fiji), with six settlements in each of Suva and Makassar randomly assigned to the intervention group (Tranche 1), and six to the control group (Tranche 2). Prior to the start of the trial, we conducted a baseline survey to collect demographics and health data in all settlements. The intervention arm involves delivery and construction of water sensitive revitalisation infrastructure. These interventions are site-specific but may include the installation or upgrading of latrines, installation of septic tanks, use of subsurface wetlands for sewage treatment, use of building-scale rainwater harvesting installation of street-scale drainage; improving roads and access; and connection to municipal sewer systems. Design and architectural teams from Monash University personalize all infrastructure to each settlement site. Government bodies at each site (City Government of Makassar in Indonesia and Department of Housing, under the Ministry of Local Government, Housing and the Environment in Fiji) are kept informed of all aspects of construction and monitoring. The original study protocol specified that Year 1 would focus on intervention design, site selection, community and individual enrolment, community engagement, and community co-design of intervention. Construction at intervention sites was planned to commence towards the end of Year 2 and to be completed by end of Year 3; followed by a 2-year post-construction monitoring period (total study length of 5 years). However, the study was substantially delayed by approximately 2 years due to the COVID19 pandemic related challenges and additional delays associated with the resumption and progression of construction activities post-COVID and other implementation challenges. As a result, the overall study duration is now expected to extend to approximately 9 years. All settlement sites receive information about the rationale of the project and its focus on water and sanitation management. Once enrolled, and for the full duration of the trial, all communities are visited by field workers at least every 6 months (this includes before and during the build of the intervention as well as after the installation of the intervention is completed). At that time, a range of health and wellbeing data are collected using questionnaires. Field workers collect fecal samples from children under 5 every 3 to 6 months and blood samples from children under 5 every 6 to 12 months. Participant recruitment is ongoing as enrolment is offered to all new residents coming into the RISE settlements. Final enrolment will cease at the end of the project. The changes to sampling frequency occurred after COVID lockdowns (2020/2021) which incurred significant project delays, necessitating protocol changes. As of 2026, there are 8069 participants enrolled in the study.