SPA consultation recap: health services consortium x Mukuru kwa Njenga segment 2 (Wape Wape), 28.11.2018

Where? True vine church

When? 28.11.2018

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? 64 residents representatives from segment 2 village Wape Wape; 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:

Survey on facilities

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 Mukuru kwa Njenga, in particular the Wape Wape area:

Mukuru Kwa Njenga has a total of 85 health facilities; Wapewape has 13

Out of 85 facilities: 83 are private, 1 is public and 1 is community based; 24 are registered whereas, 61 have no form of registration; Most of the workers in the facilities are nurses and lab technicians; none of the facilities are NHIF compliant.

Household-level findings

  • Coughing, fever, diarrhoea, headache and diabetes are the common diseases that are spread at the household level.

  • When some residents fall sick, they tend to spend less on food or buy food on credit in order to afford hospital charges/bills.

  • Residents added more needed to be done to improve water services in order to access clean and safe water for use. In addition, a gap was identified whereby drainage systems needed to be reconstructed to reduce flooding within the settlement. Additionally, they expressed the need to improve the clinics and carry out awareness creation on hygiene.

Residents views on the survey findings

  • The government should build hospitals within the area to serve the larger population within the settlement.

  • The government should conduct backgrounds check in hospitals/clinics to streamline the systems and ensure smooth delivery of quality health care.

  • Some doctors request for bribes in order to administer medication even when there is adequate supply of drugs in the hospitals.

  • The public hospitals commonly refer patients to private hospitals which many at times are unaffordable to most residents.

  • Residents are commonly prescribed pain killers as the only form of medication after receiving treatment from the public hospitals.

  • The health officers should also be invited in the community forums to help address some of the issues that maybe raised.

  • Awareness creation should be carried out on the need to consume balanced diet comprising of all the required nutrients; protein, carbohydrate and vitamins

  • Residents should also be sensitized on the need to consume/ eat a lot of vegetables as well as small quantities of meat.

  • Food vendors cooking along sewer lines/ drainage points easily expose their food to germs causing contamination and outbreaks of diseases.

  • The HIV infected persons are required to have constant access to clean treated water to avoid being infected easily by diseases.

  • Persons with chronic diseases are normally at risk of acquiring a weak immune system in cases whereby they maybe consuming a poor diet.

  • Residents normally acquire medical services from chemists and herbalists in cases where one may require treatment.

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

HEALTH AT THE FACILITIES-LEVEL

ISSUES

  • Lack of adequate medicines posing a serious challenge for health care institutions and often interfering with patient care.

  • Lack of enough doctors in the available heath care centers leading to poor health outcomes.

  • Unlicensed clinics and chemists offering substandard patient care to the residents seeking treatment in hospitals.

  • Lack of free public sanitation facilities causing a negative staggering effect on health putting residents at risk.

  • Lack of appropriate hospital equipment/shortage of quality medical equipment, impacting negatively on patient care and service delivery in hospitals.

  • Ignorance of doctors and lack of adequate patient care causing detrimental effect on patients seeking treatment.

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

  • High NHIF tariff which may be unaffordable to most residents in need of the service.

EFFECTS

  • High mortality cases attributed to poor health care provided in the health care facilities.

  • Congestion of patients in the available health care facilities lowering the general performance in the health facilities.

  • Late or wrong diagnosis resulting in terrible consequences for medical patients, including physical as well as financial.

  • Usage of expired medicines which may be less potent, whereas some medications may become toxic when used beyond the expiration date.

  • Poor hygiene (domestic/personal hygiene) leading to the outbreak of diseases ie; cholera and typhoid.

SUGGESTED SOLUTIONS

  • Liaising with community and county government immediately to get constant supply of medicine in the health care centers.

  • Tasking community and county government to ensure more doctors are immediately stationed in the available health centers.

  • Tasking the County Government, Local administrators and Nyumba Kumi to immediately crack down on facilities operating without the required license.

  • Constructing proper public sanitation facilities immediately with adequate supply of water through liaising with the community, Nyumba Kumi and County Government.

  • Engage County Government and Community to immediately look into constructing a properly equipped hospital that will serve the larger population.

  • Engage community and County Government to take up strict measures upon doctors operating without the required qualifications.

  • Liaising with County Government to station ambulance services to serve the community in cases of emergencies.

  • Engage County Government in a bid to immediately reduce the current NHIF tariff fee to 160/= to allow patients access the service.

HEALTH AT THE HOUSEHOLD-LEVEL

ISSUES

  • Poor community drainage systems to facilitate smooth redirection of waste water to required points.

  • Poor sanitation standards leading to the spread/ outbreak of sanitation-related illnesses like cholera which can spread rapidly.

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

  • Consumption of unclean/untreated water leading to the rapid outbreak and spread of water borne diseases.

  • Congestion and overcrowding within the settlements facilitating the spread of infectious diseases.

EFFECTS

  • Rapid spread of waterborne diseases affecting area residents including children.

  • Diarrhea characterized by the passing of loose brought about by consuming contaminated food.

  • Infections caused by germs and bacteria which spread and affect the human body.

  • Chest problems/ complications that maybe caused by medical conditions affecting any of the organs

  • Poor /unbalanced diet causing malnutrition resulting to the development of diseases and other chronic health conditions.

  • Long-term exposure to air pollution resulting in significant health problems including: increased respiratory diseases. 

SUGGESTED SOLUTIONS

  • Engaging Community and County government to immediately oversee re-construction of proper community drainage systems.

  • Liaising with relevant Government officials and community to oversee construction of sewer lines in the long term.

  • Tasking the Government, Community and relevant NGOs to immediately oversee the construction of community sanitation facilities (toilets) for use by the residents.

  • Liaising with individuals, Community Health Volunteers (CHVs) and Nyumba Kumi to immediately help create awareness on the importance of maintaining hygiene.

  • Creating awareness immediately on the importance of consuming a balanced diet.

  • Tasking the County Government, relevant NGOS and Nairobi water to oversee proper piping and treatment of water meant to be supplied to the households for domestic use.

  • Engage structure owners and the larger community to ensure construction of structures is efficiently carried out. 

  • Engage the Ministry of Health in creating awareness on the use of family planning.

 

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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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