SPA consultation recap: health services consortium x Mukuru kwa Reuben Segment 4 (Kosovo & Railways), 16.11.18

Where? Redeemed Church

When? 16.11.18

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? 80 resident representatives from Mukuru kwa Reuben segment 3 villages of Kosovo and Railways; 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:

Community members were taken through the findings of the health consortium’s earlier survey of Mukuru, with particular focus on the seven health facilities identified in each of Kosovo and Railways. Participants then broke into two groups, one for each area and discussed their issues, the effects of these issues on the community, and their suggested solutions.



  • Lack of clean water to use at the household level.

  • Lack of enough sanitation facilities at the community for use by the residents.

  • Unbalanced diet due to the quantity and quality of food purchased by residents from the low income households.

  • Poor sanitation and low hygiene standards with lack of interventions leading to rampant spread of disease within the settlement.

  • The coverage of basic health services, including vaccination, is usually lower among community residents, increasing their vulnerability to vaccine preventable diseases.

  • Disposal of liquid and solid waste on drainage sites resulting to sever flooding within the settlement at the onset of rain.

  • Shortage of health care professionals and inadequate public health facilities hindering delivery of quality health care to residents.

  • Poor record keeping in health facilities hampering the care that patients receive making it difficult for healthcare professionals to deliver quality health care.


  • Rapid spread of diseases ie; poor sanitation and lack of access to clean food and water contributes to rapid spread of diarrhea within the settlement.

  • Emission of foul smell from the dumped waste materials.

  • Malnutrition as a result of inaccessibility to the necessary healthy foods.

  • Displacement of property at the onset of heavy rains as a result to flooding within the settlement.

  • Expired medication- On some occasions, some health facilities prescribe cheap generic drugs or even expired ones to residents seeking medical care.

  • Health facilities within the settlement are also limited, unequipped and understaffed thus impacting on the health and well-being of people living in the settlements.

  • Poor sanitation standards partly leading to the spread of diarrheal disease and high mortality among children within the settlement.

  • Lack of ambulances due to the poor state of roads within the community and this therefore renders it hard for the residents to access basic services from the government.

  • Ignorance of doctors while administering their services to the patients requiring health care.

  • Poor disposal of wastes materials as these polluted areas are always accessible to individuals, especially children predisposing them to physical hazards.

  • Lack of space to construct health facilities and accommodate parking of vehicles while accessing a given facility.

  • Issuance of overdose or under dose medication resulting to poor patient outcomes.


  • Community members and county government to allocate themselves a short period of time to construct proper drainage system to curb water accumulation that subsequently leads to flooding and disasters.

  • Water tanks used to store water for domestic use at the household level should also be cleaned by individual users within a short time period.

  • Proper maintenance of toilets and public washrooms and installation of proper sewer systems within the community. These activities are also scheduled to be undertaken by individuals, collective community and the government within a short period.  

  • Awareness creation to be carried out by each individual and the community as a whole on the importance of having a balanced diet and cleaning food meant for consumption before cooking.

  • Setting a apart a short period of time as community residents, parents, food vendors and government officials  to carry out awareness by  on personal hygiene maintenance and the importance of treating water meant to be supplied for use within the community.

  • Sensitization and awareness creation to be carried out within a short period by the community and the county government on the importance of immunization of infants and young children.

  • Allocating ample period to cater for the installation of street lights by the county government to boost security within the settlement.

  • Setting apart 6 months to task the county government to station qualified doctors in each health facility and properly equip the facilities for better service delivery.

  • Provision of integrated health facilities by the county government to take one year

  • Provision of space by community residents within a year to pave way for construction of well-equipped facilities.




  • Poor solid and liquid waste management posing as an environmental health hazard to the surrounding environment.

  • High prevalence of malnutrition due to poor nutritional standards.

  • Mushrooming in the houses due to leakage especially in the rainy seasons

  • Lack of enough public health facilities within the settlement for access by residents seeking medical care.

  • Poor data record keeping methods in health care centers to help in the medical evaluation and review of patients.

  • Lack of transportation means to hospitals in cases where emergencies arise.

  • Lack of laboratory services laboratory and other health care infrastructures impeding the deliverance of quality health care.

  • Absence of mortuary services in some health care institutions

  • Incompetent health personnel attending to patients thus patients suffer harm as a result of errors in their care

  • Failure to administer immunization to young children to protect them from contracting diseases at a young age.

  • Improper disposal of drugs and waste causing significant harm to community residents.

  • Service provision centered in one area as opposed to adequately dispersing services to all areas for access by area residents.


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

  • Malnutrition resulting to both short and long term irreversible negative health outcomes.

  • High cost of health services whereby most of the community residents incur significant health expenses to access medical care.

  •  Unqualified doctors offering services in health centers and clinics resulting in cases of misdiagnosis of patients.

  • Lack of ambulance services required to transport ailing residents to health care centers.

  • Poor infrastructure coupled with lack of adequate equipment necessary in administering quality health care to patients.

  • Lack of space; congestion in mortuaries

  • Malnutrition causing long term health complications

  • Polluted environment due to dumping of waste as well as poor waste management strategies.

  • High cases of patience being referred to other health care centers to seek treatment.


  • Zoning one defined area to serve as a community dump site. Action to happen immediately through facilitation from the county government and community at large.

  • Immediate installation of a proper sewer lines by the county government and the community.

  • Immediate awareness creation on the need to have a balanced diet.

  • -Lowering costs incurred to access health care by community residents thus emergence of affordable health facilities. Action proposed to be implemented immediately.

  • Standardization of houses to be carried out by the county government within a year.

  • Installation of streetlights to boost security within the settlement by the county government within a year.

  • Setting up a well-managed police station within the settlement and creating awareness on the need to report cases to the relevant authority within the area. Action to be implemented within a year by the county government and other stake holders.

  • Construction of more public health facilities with qualified health practitioners. Action proposed to be implemented within 2 years by the county government and national government.

  • Digitization of a facilities’ documentation work by health care providers for quality record keeping within one month.

  • Setting up additional mortuaries that also serve to provide hygiene storage in hospitals. Action to be implemented within one month by the county government.

  •  Taking legal action against unqualified doctors rendering health services in hospitals. In addition, installation of CCTVs should be adopted in each facility. Action was proposed to be executed immediately by the Kenya medical board and the County government.

  • Immunization sensitization to be conducted immediately by the county government.

  • Immediate implementation of concrete laws that prohibits the prescription of expired medicine by health care providers.


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.

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