Health services consultation: Viwandani segment 2 (Jamaica, Lunga-Lunga Centre & Milimani), 23.11.2018
Where? Lunga-lunga Pentecostal Church
When? 23.11.2018
What? Health Services consortium consultation meeting (the consortium = Kenya Medical Association, Kenya Red Cross, Innovative Canadians for Change, Slum Dwellers International-Kenya, University of California Berkley, and Akiba Mashinani Trust)
Who? 53 residents representatives from segment 2 villages of Milimani, Lunga-Lunga Center, and Jamaica; Muungano alliance federation and support professionals; representatives of the Kenya Red Cross.
About the community consultations:
This note is from the first of three sets of community consultations by the health services consortium of the SPA.
This first set of consultation meetings are segment-level dreaming sessions, where residents share their views and aspirations with the consortium, and where the consortium works with the community to identify issues and challenges, community priorities, and ideas for potential solutions – all relating to health services.
After the first consultation meetings, the consortium will develop a draft sectoral plan for the segment – this draft sectoral plan will be derived from the dreams shared in the first set of consultation meetings and tested against the existing reality of Mukuru.
In later sets of meetings, first at segment level, the consortium will seek residents’ feedback on these draft plans, which will then be revised accordingly. And then all 8 of the SPA consortiums will together share the final integrated development plan, for adoption by Mukuru’s residents.
Brief notes on the discussion:
Community members were taken through the findings of the health consortium’s earlier survey of Mukuru, with particular focus on the type and number of health facilities identified in each of villages in the segment.
Community participants were also taken through the Kenyan Constitution as it defines requirements for the six levels of health services, ie as follows:
Community health volunteers (CHVS), meant to cater to 5,000 people
Dispensaries and clinics, meant to serve 10,000 people
Health centers, supposed to serve 30,000 people
Primary health care centres, meant to serve 100,000 people
Secondary care hospitals, meant to serve one million people
Tertiary care hospitals, meant to serve 5 million people
Participants then broke into a number of groups, one for each village, and discussed their issues, the effects of these issues on the community, and their suggested solutions.
MILIMANI
ISSUE: Poor solid and liquid waste management
EFFECTS: Outbreak of diseases as result of contamination; High mortality cases as a result of health and environmental risks related to poor waste management at the community level; Pollution resulting to the spread of harmful bacteria and germs within the surroundings; Blocked sewers causing significant negative health impacts; Burns and other injuries as a result of poor handling, collection, transportation and dumping of waste materials.
SUGGESTED SOLUTION: Permanently zoned community dumping site
TIMELINE: Immediately
RESPONSIBILITY: Community; National and County Government and other relevant; NGOs.
ISSUE: Circulation of dirty water for domestic use and lack of adequate sanitation facilities.
EFFECTS: Absence of adequate sanitation facilities impacting seriously on health as it leads to rapid spread of diseases; Pollution due to unimproved sanitation facilities, and poor hygiene practices; Blocked drains and burst sewers from pressure impact of waste materials on drainage sites.
SUGGESTED SOLUTION: Construction of proper community drainage systems; Distribution of clean and safe water for domestic use; Thorough cleaning of tanks meant to store water for use by residents.
TIMELINE: Immediately
RESPONSIBILITY: Community; National and County Government, relevant; NGOs.
ISSUE: Floods
EFFECTS: High cases of death and injuries; the aftermath of heavy floods; Poverty as a result of displacement of ones property following heavy rains; Heavy flooding potentially increasing the transmission of water-borne diseases.
SUGGESTED SOLUTION: Re-construction of proper community drainage systems.
TIMELINE: Immediately
RESPONSIBILITY: community; national and county government; NGO
ISSUE: Air pollution
EFFECTS: Outdoor air pollution causing both acute and chronic respiratory diseases; Increased cases of premature death and disability due to air pollution.
SUGGESTED SOLUTION: Constant inspection and imposing fines on individuals polluting the environment
TIMELINE: Immediately
RESPONSIBILITY: community; national and county government; NGO
LUNGA LUNGA CENTER
ISSUE: Inadequate medicine supply in hospitals.
EFFECTS: Loss of life due to inadequate access to high-quality medical care and issuance of wrong medication or expired medication; Prolonged sickness contributing to poor response to pharmacological treatment.
SUGGESTED SOLUTION: Adequate supply of medicines; Enhance hospital management systems for quality long term performance; Monitoring prescription/ issuance of medicines to patients.
TIMELINE: Immediately
RESPONSIBILITY: county and national government; community; and relevant NGOs
ISSUE: Unqualified doctors
EFFECTS: Unqualified medical practitioners prescribing wrong medications to patients seeking treatment.
SUGGESTED SOLUTION: Conducting constant follow ups to ensure all health facilities are licensed; Ensuring relevant authorities carry out constant inspections in all health care facilities to streamline the system; Stationing qualified doctors in all health care facilities.
TIMELINE: Immediately
RESPONSIBILITY: community; national and county government; NGO
ISSUE: Proper health facilities
EFFECTS: High mortality rates due to low quality health care systems; Lack of quality care in hospitals limiting women to bear children at home; High cost of medical care prompting most residents to seek alternative care which many at times maybe unsafe.
SUGGESTED SOLUTION: Stationing operational ambulances in the community to serve residents in cases of emergencies; Following up to ensure the available health care facilities are operational on a 24 hour basis; Upgrade and properly equip the available health care facilities within the area.
TIMELINE: Immediately
RESPONSIBILITY: Community; national and county government; relevant NGO
ISSUE: Language barrier
EFFECTS: Language barriers limiting patients from accessing health care in hospitals
SUGGESTED SOLUTION: Training health care workers who speak local languages to reduce linguistic barriers while receiving treatment.
TIMELINE: Immediately
RESPONSIBILITY: Community; national and county government; relevant NGOs
JAMAICA
ISSUE: Poor drainage
EFFECTS: Rapid spread of diseases due to consumption of unclean water, poor sanitation, and hygiene practices; Poor drainage systems which many at times leads to flooding and destruction of properties.
SUGGESTED SOLUTION: Construction of proper drainage systems to combat blockage that causes flooding; Setting up concrete community waste management systems.
TIMELINE: Immediately
RESPONSIBILITY: community; national and county government; NGO; ministry of health
ISSUE: Unqualified doctors
EFFECTS: Serious health injuries and deaths of patients caused by negligent health providers and issuance of wrong prescription.
SUGGESTED SOLUTION: Stationing qualified health providers in the available health care facilities.
TIMELINE: Immediately
RESPONSIBILITY: Community; national and county government; relevant NGOs
ISSUE: Nutrition
EFFECTS: Poor nutrition contributing to the risk of developing illnesses and other health complications.
SUGGESTED SOLUTION: Awareness creation on the need to consume a balanced diet.
TIMELINE: Immediately
RESPONSIBILITY: community; national and county government; NGOs
ISSUE: Air pollution
EFFECTS: Constant air pollution leading to contraction of respiratory diseases.
SUGGESTED SOLUTION: Zoning a clearly defined dumping area and overseeing industrial management of the harmful air/gases emitted from the industries.
TIMELINE: Immediately
RESPONSIBILITY: Community; national and county government; relevant NGOs
About the Health Services consortium:
The Health Services consortium is one of the 7 sectoral consortiums* under the Mukuru SPA. It is led by Nairobi City County and supported by several non-governmental organizations—Kenya Medical Association, Kenya Red Cross, Innovative Canadians for Change, Slum Dwellers International-Kenya, University of California Berkley, and Akiba Mashinani Trust
This consortium is mandated to establish the prevailing situation in the planning area, which encompasses the three areas of Mukuru kwa Reuben, Mukuru kwa Njenga, and Viwandani, in terms of residents’ health, healthcare facilities in/around Mukuru and how they are run — and how the Mukuru SPA planning process relates to various policies and frameworks, including:
Kenya’s commitment to achieving SDG 3 “Ensure healthy lives and promote well-being for all at all ages”
healthcare financing in County’s development plan
state responsibilities set out in the Constitution
Kenya’s Vision 2030 “to provide a globally competitive and thriving country with raised standards of living”
National Health Policy 2014–2030, which sets out state/County duties for: eliminating communicable diseases; halting/reversing the rising burden of non-communicable conditions; reducing the burden of violence/injuries; providing essential healthcare; minimising citizens exposure to health risk factors; strengthening government collaboration with private/other health-related sectors
Kenya’s ‘Essential Package of Health Services’ the government is providing/aspiring to provide to its citizens, in an equitable manner
Kenya’s Essential List of Medicines, which defines the priority for investment in medicines by the public sector and the government’s ability to regulate the quality/availability of medicines
National Health Insurance Fund, the primary provider of health insurance in Kenya
The Health Services consortium is doing this by: conducting theme-specific surveys and research in Mukuru; identifying gaps in the existing literature and information; and preparing a sectoral situation analysis report.
Key to all of this is the consortium’s community consultation mandate – which is to sit with Mukuru’s residents, and listen and gather their views on how they want health service provision in their neighbourhoods to be transformed. These views will then be adopted into revised sectoral plans, and finally harmonized—together with the community views collected by the other 6 SPA sectoral consortiums—to create an ‘integrated development plan’ for Mukuru.
The SPA process is designed to be community driven, and participation of the community is a requisite. The Kenyan Constitution makes the County governments responsible for ensuring this right to participate in decision-making on matters affecting citizens is observed. But crucially, in order to ensure that the community contributes to such participation forums from an informed perspective, it’s important for them to properly understand their situation.