Where? Shofco

When? 30.11.2018

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? 80 residents representatives from the segment 4 village of Vietnam; Muungano alliance federation and support professionals; representatives of the Kenya Red Cross.

>What is a segment and how are the consultations organised?

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:

Survey on facilities

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 Mukuru kwa Njenga, in particular the Wape Wape area:

Mukuru Kwa Njenga has a total of 85 health facilities; Vietnam has 14

Out of 85 facilities: 83 are private, 1 is public and 1 is community based; 24 are registered whereas, 61 have no form of registration; Most of the workers in the facilities are nurses and lab technicians; none of the facilities are NHIF compliant.

Household-level survey findings

*Common types of disease at the household level are; coughing, fever, diarrhea, headache and diabetes.

*When some residents fall ill, they normally cut on food expenditure to afford hospital charges whereas others buy food on credit in order to pay for hospital bills.

*Most residents’ want improved toilets/ sanitation facilities, access to water, improved drainage systems to combat floods, improved clinics and constant awareness creation on hygiene.

 Facilities-level survey findings

-The clinics lack water even for use by patients.

-Water is commonly available in clinics that have maternity services.

-Some clinics sell bottled water at KSH 20/=

-The health centers lack adequate medicine supply for its patients’.  

-In health centers, outpatients pay for toilets.

-In facilities, patients may be given a card or one may be required to buy an exercise book at KSH 10. The book is used for record keeping

-In a chemist there is are no forms of record keeping, one is just prescribed some medicines

-Residents opt to go to the chemists because they are close, and one can acquire services at any time.  They sell cheap medicines at an affordable rate for the residents.

-Health centers are expensive as one ends up paying for a number of services but in chemist you are given medicines depending on the amount you may have.

-In health centers, one is commonly referred to chemists to buy medicines.

-Chemist refers patients to other hospitals like Mama Lucy, Pumwani, Kenyatta and Makadara.

Residents views on the survey findings

-There are common cases of diarrhea as a result of pollution; Poor garbage disposal and water pipes run through sewer lines.

-Residents consume contaminated food mostly purchased from food vendors.

-Residents acquire headaches mainly due to stress, smell from sewages and toilets as well as poor ventilation in the houses

-Houses have windows but most people do not open the window in fear of theft.

-Present lifestyles have been the main causes of diseases such as diabetes.

-There is a need to maintain a balanced diet that comprises of; carbohydrates, vitamins, proteins.

-Main causes of colds and coughs; smoke from industries, perfumes, smoke from stoves & jiko and smoke from burnt garbage

-Most women have not registered NHIF because they don't have documents such as birth certificates for their children whereas others don't have IDs.

-Others fail to register for NHIF given their financial status.

-Health facilities should be improved.

-Awareness creation on hygiene should be conducted mainly targeting food vendors

-Awareness on health matters should also be equally created.

 

Participants then broke into groups and discussed their issues, the effects of these issues on the community, and their suggested solutions.

HEALTH ISSUES AT THE FACILITIES-LEVEL

• Lack of medicine in facilities creating an overall negative impact on patient care.

• Poor management systems impacting negatively on quality service delivery.

• Lack of enough facilities to serve the wider population within the settlement.

• Lack of ambulances to facilitate transportation of ailing residents to health care facilities to seek treatment.

• Lack of adequate sanitation facilities and sufficient supply of water in the hospitals impacting negatively on patient care.

EFFECTS

• High mortality rates as a result of low quality health care systems.

• Rapid spread of diseases and infections attributed to low hygiene standards.

• Lack of treatment/access to medication posing significant health risks on ailing residents.

• Contamination through consumed food/ water causing diarrhoea.

SUGGESTED SOLUTIONS

• Engage the County government to ensure medicines are immediately supplied in the hospitals.

• Task the community and county government to ensure awareness creation on hygiene and cleanness has been carried out immediately.

• Task the County Government to ensure infrastructure is immediately improved.

• Task the County Government to ensure ambulances are immediately stationed at the community to serve the residents.

• Task the community and County Government to undertake construction of public facilities within the area.

• Liaise with the county government and community to oversee zoning out of a clearly defined dumping site/ area immediately.

• Task the County Government to immediately avail water taps in the health facilities.

HEALTH ISSUES AT THE HOUSEHOLD-LEVEL

• Lack of adequate sanitation facilities at the household level.

• Distribution of water through leaking water pipes contaminating the water.

• Careless dumping of garbage contributing to environmental pollution and degradation.

• Congestion in houses and poor ventilation impacting negatively on ones’ health.

• Low hygiene standards leading one to acquiring potentially serious diseases/ illnesses.

EFFECTS

• Outbreak and rapid spread of diseases ie; diarrhoea attributed to low hygiene standards.

• Suffocation due to poor ventilation of households.

• High mortality cases attributed to poor health standards.

SUGGESTED SOLUTIONS

• Task the larger community, structure owners and County Government to ensure proper sewer lines have been constructed immediately.

• Task the community and Nairobi water to ensure immediate installation of iron pipes to channel water to required points.

• Liaise with the larger community and County Government to ensure proper methods of waste disposal have been adopted.

• Liaise with the larger community and County government to ensure a proper housing plan has been put in place.

• Task the Community, Government and relevant NGOs to conduct awareness creation on hygiene.

• Task the community, structure owners and the Government to immediately ensure houses are properly built with proper ventilation.

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.