SPA consultation recap: health services consortium x Mukuru kwa Reuben segment 1 (Feed the Children, Gatope & Mombasa), 22.11.2018

Where? Baptist Church

When? 22.11.2018

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? 75 resident representatives from segment 1 villages of Feed the Children, Gatope & Mombasa; 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 type and number of health facilities identified in each of villages in the segment (12 in Feed the children, 9 in Gatope, 2 in Mombasa).

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 two groups, one for each area and discussed their issues, the effects of these issues on the community, and their suggested solutions.



  • Poor drainage causing significant health hazard within the settlements due to prevalent uncontrolled waste and excreta disposal.

  • Overpopulation which is among the most pressing environmental issues within the area posing major repercussions to public health.

  • Medical negligence from doctors resulting to serious harm and far-reaching psychological and social effects on patients.

  • Poor ventilation of houses leading to the buildup of mould and condensation in homes posing a serious health    hazard to the occupants.

  • Poor/low hygiene standards resulting from inadequate domestic and personal hygiene exposing individuals to germs and infections.

  • The current status of inadequate sanitation facilities has led to the significant rapid spread of diseases attributable to insufficient facilities at the community level.

  • Poor community drainage systems to help direct excess surface water thus resulting to accumulation (stagnant water) and spread of water related disease.

  • Poor solid and liquid waste management systems posing as an environmental hazard to residents living in the area.


  • Emergence of diseases attributed to low hygiene standards and contamination from consumption of unclean water and unsafe food.

  • Displacement of property as a result of flooding due to poor drainage systems that can help channel excess water to the required points.

  • High mortality and paralysis cases as a result of exposure to different health risks over a period of time.

  • Rapid spread of diseases crippling ones productivity and ability to perform in other areas as expected.


  • Tasking the county government, NGOs and the larger community to immediately look into ways whereby community drainage systems can be re-constructed to allow easy run off of excess surface water.

  • Immediate awareness creation to be carried out by the county Government, the community at large and relevant NGOs on the need to adopt safe family planning methods and embrace the use public toilets as opposed to the use of other unsafe sanitation alternatives popularly used.

  • Immediate crackdown by relevant government officials of unregistered health facilities operating within the area

  • Engaging house owners/ elders while creating community awareness on the importance of ventilating ones house on a daily basis.

  • Tasking the community as a whole and relevant NGOs to create awareness on the importance of maintaining general and personal hygiene.

  • Immediate follow up by county government and the larger community to ensure construction of sanitation facilities is carried out at every household level.

  • Tasking the county government to immediately oversee proper construction and maintenance of community sewer lines.



  • Poor community drainage systems creating unsanitary conditions for residents within the community thus contributing to environmental degradation.

  • Exposure to improperly handled waste causing respiratory problems and other adverse health effects.

  • Consumption of unclean water resulting to contraction of water borne diseases, diarrhea and other serious illnesses.

  • Inadequate health care facilities offering substandard services to its patients seeking treatment.

  • Lack of medical supplies and unqualified health personnel creating a barrier in delivering health services to patients.

  • Barriers impeding easy accessibility to health care centers; Lack of ambulance services for use during medical emergencies.


  • Unqualified medical personnel issuing wrong prescription to patients seeking medical care.

  • Exposure to higher health risks ie; unhygienic and unsafe environmental conditions resulting to disabilities and deaths.

  • Outbreak of diseases due to consumption of untreated water, unimproved sanitation standards and poor hygiene practices.

  • Exposure to foul air as a result of air pollution leading to respiratory infections and other health complications.

  • Water accumulation resulting to blocked drainages, posing a serious health risk to residents.


  • Immediate intervention by county government, NGOs, community and churches to oversee proper re-construction of community drainage systems.

  • Immediate intervention by the community, NGOs and county government in zoning one distinct community dumping zone.

  • Immediate construction of cheap community sanitation facilities by the county government and relevant NGOs.

  • Liaising with the County government to help oversee immediate construction of well-equipped public health facilities.

  • Conduct follow ups with the county government to help oversee immediate supply of medical supplies to hospitals within the settlement.



  • Lack of adequate health care centers to efficiently serve the larger community.

  • Unqualified health personnel, few hospitals and healthcare centers translating to high patient burden at the hospitals.

  • Improper disposal of waste creating adverse health effects on humans resulting to several diseases and in some cases even, death.

  • Rapid spread of diseases caused by germs and parasites resulting from inadequate domestic and personal hygiene and poor drainage systems.

  • Poor nutrition contributing to the risk of developing some illnesses and other health complications.


  • Rapid spread of diseases due to consumption of dirty water at the household level, unimproved sanitation, and poor hygiene practices.

  • Exposure to various adverse health risks which in the long term may result to death or disabilities.

  • Constant flooding as a result of poor drainage systems impeding easy run off of surface water to required points.

  • High levels of malnutrition due to consumption of unbalanced diet.

  • Poor household ventilation causing respiratory diseases and suffocation due to poor aeration.


  • Tasking the county government, national government, community and relevant NGO to take up construction of more properly equipped hospitals within 6months.

  • Tasking the national government, county government, community and NGO to immediately ensure training of medical personnel has been carried out.

  • Immediate zoning of community dumping points/areas for efficient garbage disposal.

  • Tasking the community to immediately take up re-construction of proper drainage systems within the community.

  • Awareness creation on the importance of consuming a well-balanced diet in a bid to maintain one’s health.

  • Tasking community and relevant NGOs to oversee the set up a functional fire emergency response system for use by the community.



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