SPA consultation recap: health services consortium x Mukuru kwa Reuben segment 2 (Bins, Simba Cool, & Rurie), 27.11.2018

Where? Baptist church

When? 27.11.2018

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? Residents representatives from segment 2 villages of Bins, Simba Cool, & Rurie; Muungano alliance federation and support professionals; representatives of the Kenya Red Cross.

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

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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 (17 in Rurie, 1 in Simba Cool, and 5 in Bins).

Initial perspectives from community participants on issues in their area:

  • Residents consume dirty water because most water pipes pass through sewers.

  • The clean water meant for drinking and other household chores is distributed by unclean water pipes.

  • Need to sensitize the residents on the importance boiling/ treating water before drinking.

  • Many people go to public hospitals because of their financial status as they are only able to afford services offered by a public health facility.

  • The food vendors lack the knowledge of handling food while observing hygiene in the process.

  • The fees paid to NHIF should be reduced to allow everyone to afford it; it should be reduced to its former price, 160/=

  • Clinics provide minor surgeries, family planning and consultation.

  • Clinics in Rorie are more because it is the largest area in Reuben.

  • It is hard for one to administer medicine if he/she has not studied medicine. We have different levels of studying medicine;

    • Pharmaceutical assistant who studies for 2 and half years and is able to administer drugs under prescription

    • Diploma - Technician studies for 3 and a half years and is able to give prescription

    • Degree - Studies for 4 years with an additional 2 years.

    • Phd - studies for 8 years

  • In a chemist, if one lacks the money required for treatment, one is required to leave their phone at the hospital after receiving treatment and in a chemist, where one is known, the patient may be allowed to take medication and pay latter.

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

BINS (Households)

ISSUES

  • Lack of enough facilities and medical equipment for use by the residents seeking treatment from the health facilities.

  • Lack of adequate medicine causing widespread negative health impacts on patients.

  • Unqualified health personnel administering treatment to patients seeking medical care.

  • Lack of emergency services for use by the residents in cases of medical emergencies.  

EFFECTS

  • Poor medical services increasing the burden of illness and health costs.

  • Poor health care contributing to excess mortality rates.

  • High miscarriage cases caused by lack of quality medical care from the professionals charged with providing it.

  • Barriers to the provision of quality health care for the residents within the settlement influencing health outcomes in the long term.

SUGGESTED SOLUTIONS

  • Tasking the government and relevant NGOs to look into adding more facilities and enough medical equipment for use by the patients.

  • Tasking the government and other relevant NGOs to look into equipping the health care centers with adequate supply of drugs.  

  • Liaising with the health officers and city council to immediately have qualified personnel stationed at every health care center and introduce strict measures to better the management systems.

  • Tasking the government and NGOs to immediately look into providing more ambulances for use by the residents in cases of emergencies.

  • Tasking the government, community and area chief to immediately hold talks with the health officers in charge in a bid to streamline the current health care systems.

BINS (Facilities)

ISSUES

  • Lack of adequate sanitation facilities posing serious health risks within the settlement.

  • Poor drainage systems to facilitate remove of excess surface water to required points thus the rapid spread of water related diseases.

  • Lack of clearly defined waste disposal points and proper waste disposal methods posing significant health risks.

  • Insufficient household ventilation increasing risks of developing respiratory health diseases/ complications.

EFFECTS

  • Lack of sufficient sanitation facilities and constant pollution causing the rampant outbreak and spread of diseases.

  • Poor drainage systems causing flooding at the onset of rainy seasons leading to the displacement of property and outbreak of water related diseases.

  • Long-term exposure to pollution resulting in significant health problems/complications.

  • Poor health standards linked to high mortality cases within the settlement. 

SUGGESTED SOLUTIONS

  • Liaising with the community, NGOs and government officials to have proper sanitation facilities constructed at the household level immediately.

  • Engage structure owners, community and relevant NGOs in order to have proper sewer lines constructed immediately to facilitate easy disposal of waste water at required points.

  • Liaising with community and government to have clearly defined community dumping zones immediately.

  • Tasking community, the government and relevant NGOs to have fire extinguishers stationed at the community to facilitate quick response in cases to emergencies.

  • Liaising with structure owners and community immediately in a bid to create awareness and sensitize community residents on the need to ventilate their houses

 

RURIE (HOUSEHOLDS)

ISSUES

  • Poor community drainage systems causing negative health outcomes on area residents.

  • Poor household ventilation leading to the buildup of mould that poses as a health hazard.

  • Lack of sufficient awareness on the different available family planning methods that can be adopted.

  • Prevalent cases of teenage pregnancy.

  • Domestic violence that may cause physical or psychological harm and subsequently affect ones overall health and wellbeing.

EFFECTS

  • Poor drainage systems to facilitate removal of excess surface water to required points hence causing blockage that leads to flooding

  • Low hygiene level causing significant negative health related risks.

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

  • Poor solid waste disposal procedures causing pollution of the environment leading to the exposure of health related risks.

  • Poor physical health which may lead to an increased risk of developing mental health/depression.

  • Poor health care offered in health centers resulting to high mortality rates within the settlement.

  • Loss of properties ie; through flooding caused by poor drainage systems to facilitate easy disposal of excess surface water. 

SUGGESTED SOLUTIONS

  • Set apart 6-12 months to oversee proper construction of community drainage sites through liaising with the government and relevant NGOs.

  • Ensuring immediate action is taken in ensuring houses are well ventilated through liaising with the structure owners.

  • Liaising with health officers, religious leaders, parents and relevant NGOs to ensure within three months, counselling/ awareness creation on family planning has been conducted.

  • Tasking village elders and religious leaders to ensure guiding and counselling sessions on domestic violence have been conducted immediately.

 

RURIE (facilities)

ISSUES

  • Poor health services holding back progress on improving health care within the settlement.

  • Mushrooming in hospitals causing respiratory illnesses/diseases once exposed.

  • Lack of ambulance services within the settlement to facilitate transportation of patients to health facilities in cases of emergencies.

EFFECTS

  • Lack of access to quality health care subsequently resulting to high mortality cases of patients seeking treatment at the health care centers.

  • Lack of essential drugs, quality medical equipment and qualified health personnel causing significant negative health effects on the health of residents seeking treatment.

  • Rapid spread of diseases through contamination due to poor sanitation/ low hygiene standards.

  •  Poor medical service being offered in health care centers ultimately compromising on quality service delivery in the available health centers.

  • Poor quality of health care contributing to excess mortality cases.

SUGGESTED SOLUTIONS

  • Liaising with the county government and community to ensure qualified health personnel are immediately stationed at the available health facilities.

  • Tasking the county government and community at large to ensure proper and well equipped health care facilities have been constructed within 2 years.

  • Tasking the County government to oversee immediate construction of roads and stationing of emergency ambulance services within the community.

 

SIMBACOOL

ISSUES

  • Poor drainage systems exposing residents to various health risks.  

  • Poor solid waste management procedures/ structures resulting to pollution and outbreak of diseases within the settlement.

  • Lack of adequate awareness on family planning methods that can be adopted.

  • Female genital mutilation; a harmful traditional practice with severe health complications.

  • Sexually transmitted diseases which may lead to lead to a variety of different health risks especially if left untreated. 

EFFECTS

  • Rapid outbreak of diseases that maybe caused by constant contamination or pollution causing various adverse health effects.

  • Blocked sewer lines obstructing the easy flow of water to required points leading to a number of complications that may affect one’s health.

  • Long-term exposure to particulate pollution resulting to significant health problems such as: Increased respiratory diseases.

  • Outbreak of infectious diseases that can be spread through contaminated water; water borne diseases such as Typhoid, Cholera

  • Lack of awareness on family planning methods which helps in having the desired number of children thus control population.

  • High mortality cases attributable to poor health standards/ substandard health care systems

  • Poverty and lack of access to quality obstetric care often leading to the emergence of fistula cases in women.

SUGGESTED SOLUTIONS

  • Liaising with county government and structure owners to ensure the community drainage systems are properly constructed within 5 - 6 months.

  • Tasking individuals, county government and structure owners to immediately look into repairing the community sewer lines to facilitate easy flow of excess surface water.

  • Tasking the county government to immediately look into stationing qualified health workers at the every health center to render quality health services to its patients.

  • Tasking community residents, county government as well as structure owners to immediately zone out community dumping sites and install quality pipes to channel water to the required points.

  • Task individuals and relevant government officials to immediately ensure expert health workers are stationed at the health care facilities.

  • Liaising with relevant government officials to ensure those carrying out FGM are arrested immediately.

  • Liaising with relevant individuals, government and NGOs to immediately ensure awareness creation on abstinence has and use of contraceptives (condoms) has been carried out.

 

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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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