Health services pre-consultation: Mukuru kwa Reuben (all segments)
The Health consortium pre-consultation with Mukuru kwa Reuben (residents from segments 1, 2, 3 and 4) was held on 9 November 2018
Where? Reuben Centre, Mukuru
When? Friday 9 November 2018
What? Health Services consortium pre-consultation meeting with Mukuru kwa Reuben area (consortium = Kenya Medical Association, Kenya Red Cross, Innovative Canadians for Change, Slum Dwellers International-Kenya, University of California Berkley, and Akiba Mashinani Trust)
Who? 61 resident representatives across all 4 Mukuru SPA Reuben segments (villages of Gatope, Feed the Children, Mombasa (segment 1); Rurie, Simba Cool, Bins (segment 2); Kosovo, Railway (segment 3); Gateway, Diamond, Wesinya (segment 4)); representatives from the Health Services consortium; Muungano facilitators.
Aims:
About pre-consultation meetings
In the SPA process, pre-consultation meetings are for a thematic consortium to meet representatives from each of the village clusters into which the planning process has divided the three huge areas that make up the Mukuru slum belt.
Meeting participants are taken through the SPA process, the structure of participation, and a situation analysis relating to the consortium’s sectoral focus. Cluster representatives and community mobilizers are then charged with disseminating this information throughout the sub-clusters for which they are responsible. In addition, village cluster representatives are tasked with overseeing the selection of representatives to sit in the segment-level consultative forums of the consortium.
Pre-consultations help to deepen communities’ understanding of the SPA, as well as dispel rumours or ‘fake news’ being spread by agents opposed to the success of the SPA – since slum communities have many competing interests positioning to capture the benefits of regularization.
They also help a consortium prepare for segment-level consultations – through understanding how their consultation messages are being conveyed by the cluster representatives to their communities, and to hear back the comments, opinions, and questions emanating from their discussions with the community.
About the community consultations
Most consortiums will hold three rounds of community consultations for the SPA process.
The 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 water, sanitation and energy. 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 the second set of meetings, also at segment level, the consortium will seek residents’ feedback on these draft plans, which will then be revised accordingly.
In the third set of meetings, 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:
The pre-consultation meeting started with consortium representatives giving an overview of the SPA process. Then the discussions began with a report back from the consortium of the findings of a health/health services survey conducted in kwa Reuben.
Findings at the settlement level:
There are 70 health facilities in Reuben. These include chemist hospitals, herbal clinics, dispensaries and faith based clinics. Of these:
66 are privately owned; 4 are government owned
62 are rented, with tenants paying about 1000-5000 and 5000-10,000 per month; 8 are individually owned
50 do not have any form of registration; 20 are registered
Only 5 facilities are NHIF compliant
6 lack sanitation facilities; 5 rely on public toilets; the rest have pit latrine or flush toilets
67 have electricity connection; 3 do not
50 are legally connected; 10 rely on illegal electricity connection
In cases of power outage candles are used within the facilities.
Most health personnel stationed in these facilities are; pharmacist, nurses, physicians, lab technicians and public health officer.
Findings at the household level
Diarrhoea, fever, headache, coughing and chest pains were the most common health issues affecting residents who live in the 4 segments in Reuben.
These diseases are mainly caused by environmental factors.
The survey showed that 43℅ of women living in Mukuru are affected by HIV/AIDS, and need a lot to care for their health
Floods affect a large number of people in Mukuru Kwa Reuben, and this is identified as a major cause of cholera in the area
Discussions
From the findings, community residents held in depth discussions and the following were some of the ideas, proposals, and suggested solutions:
Improve and maintain the existing sanitation facilities
Treat drinking water to avoid acquiring diseases such as cholera
Awareness creation on the importance of maintaining hygiene standards
Improve all community drainage systems to reduce cases of extreme flooding
People should take personal responsibility for ensuring water tanks are cleaned and water supplied at the household level is treated
Residents also gave views, feedback and suggestions relating to healthcare services and facilities available to people living in Reuben:
Most chemists are not affordable and do not offer quality services
Chemists offer medicines depending on the amount of money offered
Some chemists operate illegally as they lack the required licenses to operate
Most residents prefer seeking medical care directly from the chemist as opposed to accessing hospital services, because chemists operate 24/7
Some chemists have qualified doctors who work at the government hospital
In case of emergency at night, accessing medical care from the chemist is easy and convenient for many residents
Chemists come in handy during the weekends where most government health facilities are lax in delivering services
Chemists are known to easily offer medicine on credit when residents can foster good relations with personnel working in in these facilities
Residents are able to access medical care from chemists promptly as they are timely in offering their services
The government hospital in Mareba offers quality services though the facility lacks medicine supplies
Reporting: Kamila Karu and Jackie Waithaka. Photos: Muungano KYCTV.
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.