SPA consultation recap: health services consortium x Viwandani segment 1 (Paradise B, Paradise C, Paradise A, Sinai B/Kwa Reli & Sinai A), 15.11.2018

Where? Community centre

When? 15.11.18

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? Resident representatives from Viwandani segment 1 villages of Paradise B, Paradise C, Paradise A, Sinai B/Kwa Reli & Sinai A.

>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, village by village:



  • Shortage of drugs in health facilities posing a serious challenge for health the health care institutions within the area and often interfering with patient care.

  • Congestion in hospitals hence facilities struggle to deliver the best health care to its patients.

  • Discrimination from doctors; not all patients are treated equally well by the health care providers while seeking treatment from the health care centers.

  • Prescribing expired drugs to patients which many at times may produce adverse effects.

    Absence of public transportation (i.e. ambulances) to transport ailing residents to health care centers whenever emergencies arise.

  • Poor hygiene practices which may include; failure to clean ones hands, consuming dirty food and drinking untreated water which many at times leave residents exposed to germs, infections and infestation.


  • Lack of proper infrastructure and health personnel has caused major setbacks in the health sector within the settlement.

  • High cases of mortality due to low quality health care systems and rapid spread of diseases within the area.

  • Poor sanitation and lack of access to safe food and water has contributed to high prevalence of diseases such diarrhoea, within settlement.


  • Tasking the government to look to look into equipping the available hospitals with enough medicine supply and constructing adequate and standard government health facilities within the settlement.

  • Government to conduct regular health inspection in the available health care facilities serving the residents within the area to ensure quality health standards are being upheld.

  • Setting apart ample duration to carry out awareness creation as a community at the household level on the importance of maintaining ones hygiene i.e. cleaning of hands after visiting the toilet.

  • Provision of tissues by the house elder at every household elder.

  • Sensitizing households to maintain and uphold food hygiene and safety throughout cooking and storage to provide high level of protection against food contamination.

  • Sensitizing residents on the need to maintain hygiene while handling and storing food.

  • Awareness creation on the importance of treating water meant for consumption at every household as this is necessary to ensure the drinking water is clean and not harmful to one’s health. 

  •  Proper disposal of community waste allowing all the waste matter released from households to be safely discarded without the risk of environmental contamination.



  • Untreated water which may contain any number of contaminants, such as: bacteria, human and animal waste causing a variety of ailments, including diarrhoea.

  • Lack of adequate sanitation facilities at the community level, impacting on the resident’s health status on numerous levels.

  • Congestion due to the constant rising population of residents within the settlement impacting negatively on community resident’s health.

  • Low hygiene standards negatively impacting on human health and wellbeing.

  • Lack of adequate health facilities and drug supply within the settlement to sufficiently serve the larger community.

  • Lack of balanced diet; poor nutritional practices which impairs an individual’s health which is core to enable the body perform its necessary functions.

  • Unaffordable medical services due to the significant increase of costs.

  • Cases of conflict between church and hospital affecting normal/ smooth operations of the affected health centre.

  • Poor community drainage systems impacting negatively on the community i.e.  the state of poor drainages manifesting in terms of rapid spread of diseases, hindrance to mobility, destruction of property and poor sanitation.

  • Inflexible hospital operating hours which many at times may hinder residents from accessing the health centres especially at night.

  • Increase of drug addiction cases which may cause many long-term negative health effects, including physical health problems.


  • Malnutrition increasing the high risk of contracting disease as the body becomes weak and easily prone to diseases.

  • Long term suffering due to poor health care services being offered, inability to afford proper health care  and unhygienic standards which in the long term contributes to the rapid spread of diseases

  • Poor existing health care system resulting in high mortality cases within the area.

  • Rapid spread of diseases causing losses in human lives and in the long term creates a burden for families

  • Environmental pollution which has adverse effects on both humans & the other environmental living things.


  • Sensitizing house elders on the importance of treating/ boiling water before consumption to kill microorganisms that can cause diseases.   

  • Sensitizing structure owners on the importance of constructing more sanitation facilities within the settlement for safe disposal of human urine and faecal matter thus maintain the hygiene standards

  • Awareness creation to be carried both at the household and at the plot level on the importance of maintaining general/ personal hygiene to help prevent development and spread of infections

  • Tasking the government to construct more public health facilities with the settlement for access by residents seeking health care services.

  •  Sensitizing every household elder on the importance of having a balanced diet to help maintain a healthy body.

  •  Sensitizing individuals on the importance of securing a health care cover (NHIF) which helps to cover medical costs and offers many other important medical benefits.

  •  Engage hospital and chemist owners in order to have them operate their facilities at a 24 hour basis every day. 

  • Setting up rehabilitation centres to serve the community residents who maybe in need of such services.




  • Poor hygiene and low sanitation standards causing significant negative health impacts to both children and adults.

  • Poor housing structures/ substandard housing which substantially influences the health and well-being of residents.

  •  Drug and substance abuse causing negative health consequences, including physical health problems like liver damage and heart disease.

  •  Unqualified medical practitioners who pose as qualified doctors and administer potentially dangerous treatments to patients.

  •  Inadequate medicines and lack of laboratory services in hospitals thus manifesting in a variety of negative health impacts.

  • High cases of unwanted pregnancies and early marriages.

  • Poverty which is currently a major cause of ill health and a barrier to accessing proper health care when needed.


  •  Rapid spread of diseases resulting to high mortality cases due to poor domestic or personal hygiene.

  • Poor health conditions as a result of poor hygiene and sanitation standards as well as consuming an unbalanced diet.

  • Poor quality health care services and inability to afford proper medical care has resulted to unnecessary deaths of young children, men and women within the settlement.

  • Issuance of wrong medication to patients causing serious risk of experiencing adverse side effects, or worsening of a medical condition.

  • Drug resistance; Reduction in effectiveness of a medication in treating diseases and other medical conditions.


  • Sensitizing household elders to ensure food meant for consumption is properly handled throughout cooking and storage as well as maintain household hygiene to avoid contraction of diseases.

  • Sensitizing house elders to adopt proper methods of waste disposal as it is critical due to the fact that certain types of wastes can be hazardous and can contaminate the environment if not handled properly

  • Creating awareness at the community level on the need of preserving and maintaining the environment to reduce health risks.

  • Sensitizing house elders on the need to ventilate their households to reduce risks of contracting respiratory diseases.

  • Creating awareness on the dangers/ risks of self-medication as it may potentially lead to sever adverse reactions.

  • Tasking the government to oversee the timely procurement and distribution of drugs to every health care center as well as increase more public health facilities to serve the larger community.

  • Government to conduct a crackdown of unregistered health facilities operating within the settlement.



  • Poor diet as most community residents can hardly afford to purchase the required balanced nutritious food required to maintain one’s health.

  • Consumption of untreated water and usage of broken/ leaking water pipes to channel water to the designated water points thus increasing risks of contracting diseases.

  • Poor sanitation due to inadequate community sanitation facilities leading to rapid spread of infections.

  • Lack of a clearly defined community garbage collection point/site to help reduce exposure to improperly handled wastes and pollution.

  • Lack of sufficient drug supply in health care facilities.


  • Rapid spread of diarrhea diseases and other water bone diseases attributed to failure to treat water meant for consumption at the household level.

  • Blocked sewages leading to stagnant water which accumulates for a long time and eventually causes substantial health risks.


  • Sensitizing water distributors to adopt the use of standard water pipes to distribute/ channel water to the house holds/plot level.

  • Awareness creation on the need to treat water meant for domestic use to prevent contamination and spread of diseases.

  • Sensitizing community members on the need to unblock the community drainage systems for easy disposal of waste water to the required sewer points.

  • Sensitizing house elders on the importance of ventilating their homes to expel buildup of pollutants and harmful bacteria.

  • Organizing youth teams to take up garbage collection within the settlement in a bid to manage pollution and curb diseases.




  • Poor household ventilation leading the growth of fungus and molds in homes thus in the long term, leads to respiratory health complications.

  • Distribution of unsafe water for domestic use resulting to increased cases of diarrhea and other water borne diseases.

  • Lack of knowledge through awareness creation on the importance of preserving ones hygiene as well as general hygiene in order to maintain one’s health.

  • Poor drainage and sewer systems resulting to spills thus exposing residents to serious health risks

  • Lack of a clearly defined community garbage point to help curb environmental pollution and manage health risks incurred through pollution.

  • Poor hygiene standards negatively impacting on one’s health and wellbeing.

  • Inadequate public hospitals coupled with insufficient medical laboratory services impedes smooth delivery of proper health care to the residents.


  • Rapid spread of diseases and infections due to low hygiene standards and usage of untreated water.

  • Poor waste management strategies causing long-term environmental and health risk to residents living within the settlement.


  • Involve structure owners while creating awareness on the need to properly construct houses with sufficient ventilation (windows)

  • Sensitizing house elders on the importance of placing cook stoves outside to prevent pollution from fumes emitted.

  • Awareness creation on the importance of treating/ boiling water meant for consumption or domestic use at the household level.  

  • Conducting awareness forums chaired by community health volunteers (CHVs) to educate residents on different ways to maintain their health.

  • Following up with relevant government authorities to secure community garbage lorries to help collect garbage for disposal at a designated area.

  • Engaging the government in order to ensure trained and qualified personnel are stationed at every health facility as well ensure each facility is fully equipped with the required medical equipment.

  • Creating awareness on the dangers of self-treating.



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.

Muungano AllianceComment