SPA consultation recap: health services consortium x Mukuru kwa Reuben segment 3 (Gateway, Wesinya & Diamond), 29.11.2018

Where? Baptist church

When? 29.11.2018

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? 80 residents representatives from segment 3 villages of Gateway, Wesinya & Diamond; 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 (4 in Diamond, 2 in Wesinya, and 14 in Gateway).

Initial responses from community participants on the survey findings about their areas: issues in their area:

HEALTH AT THE FACILITIES-LEVEL

  • Most of the available facilities are expensive and privately owned thus unaffordable to the area residents. 

  • Mareba Hospital (public hospital) lacks adequate supply of medicines. 

  • Residents are unsure about the qualification levels of the health workers operating within the health institutions.

  • Some chemist have maternity services but aren’t qualified to provide the service.

  • Most residents do not have a complete understanding of dispensaries and clinics; roles each regarding patient care.

  • Most of the chemist perform equal functions as the hospitals.

  • There should be strict measures put in place to streamline the licensing process of the health care facilities to ensure only the licensed facilities are operating. 

  • Constructing a 24 hour dispensary to ensure it serves the larger community especially during emergency cases.  

HEALTH AT THE HOUSEHOLD-LEVEL

  • Lack of sanitation facilities that operate at night and given the current status of insecurity, residents opt to use buckets and flying toilets as alternative means.   

  • Water tanks used to store water are many at times left open leading to contamination.

  • To avoid consuming dirty water, one is meant to boil the water at 100°c and wait for it to cool before consumption.

  • Water is easily contaminated especially because the pipes pass through sewer lines.

  • Water treatment can be done through using water guards and aqua tabs.

  • Drainage systems helps to drain excess surface water to the required water points and with poor drainage systems, diseases such as typhoid, malaria and diarrhea are easily spread.

  • High NHIF tariff proving unaffordable for most residents.

  • Congestion, dirt and polluted gases from the industries, are the major causes of chest complications

  • Awareness on food hygiene should be carried out.

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.

Wesinya (Household-level)

ISSUES

  • Poor community drainage systems causing flooding and results to damage of properties and displacement.

  • Poor waste disposal methods causing pollution and exposes residents to the risk of contracting diseases.

  • Congestion in houses causing detrimental impact on one’s health.

  • Poor sanitation standards leading to the outbreak of sever sanitation-related illnesses like cholera.

  • Gender based violence impacting negatively on women and girls who may have undergone abuse.

  • Lack of adequate sanitation facilities posing sanitation challenges.

EFFECTS

  • Rapid outbreak of diseases attributed to the low sanitation standards within the settlement.

  • Bad/ foul smell due to pollution of the environment. 

SUGGESTED SOLUTIONS

  • Tasking community and County Government to immediately facilitate proper reconstruction of drainage systems.

  • Liaising with the County Government to immediately facilitate the installation of a community water token system.

  • Engage the community and County Government to support the setting up of recreation centers immediately

  • Engage the community, structure owners and the County Government to immediately facilitate awareness creation on family planning and proper ventilation of houses.

Wesinya (facilities-level)

ISSUES

  • Lack of adequate dispensaries and hospitals for access by residents in need of medical care.

  • Unqualified health personnel.

EFFECTS

  • Overdose and under dose resulting to negative patient side effects.

  • High cost of medical care curtailing residents from accessing medical care in the available health care centers

  • Wrong prescription of drugs leading to harmful/ dangerous side effects

  • Increased mortality cases attributed to the low-quality health care systems.

  • Drug resistance leading to prolonged hospital stays, and increased mortality rates.

  • Expired drugs reducing potency to respond and cure an illness.

SUGGESTED SOLUTIONS

  • Task the community and County Government to immediately oversee dispensaries are sufficiently equipped to serve the community at large.

  • Engage community, County Government, the Kenya Red Cross and the Ministry of Health to ensure qualified doctors are stationed at the health care facilities and the ambulances are available for use during emergency cases.

  • Liaise with the Community, Ministry of Health and County Government to ensure all chemists operating within the settlement are registered immediately (community, ministry of health and county government)

 

GATEWAY (Household-level)

ISSUES

  • Lack of proper community drainage systems adversely affecting the environment.

  • Poor solid waste management techniques impacting negatively on human health

  • Lack of sanitation facilities for use by the residents resulting to hygiene-related diseases ie; diarrhea.

  • Lack of adequate water for use at the household level compromising on overall hygiene resulting to the outbreak of diseases.

  • Lack of proper ventilation of houses leading to the buildup of poor indoor air quality.

EFFECTS

  • Outbreak of diseases caused by poor hygiene standards.

  • Blocked drainage systems obstructing easy drain of surface water to prevent flooding.

  • Environmental pollution through introduction of harmful pollutants that contaminate the surroundings affecting one’s health.

  • Water pollution leading to contamination and outbreak of diseases such as cholera.

  • Spread of infections caused by germs and bacteria.

SUGGESTED SOLUTIONS

  • Engage community, County Government and the Kenya Red cross to immediately oversee reconstruction of the drainage systems, and proper disposal of waste products.

  • Task the community, County Government and Kenya Red Cross to immediately zone out a clearly defined community dumping site.

  • Tasking County Government to immediately improve the water piping system, increase water tanks and introduce a water ATM to allow for easy water distribution.

  • Tasking the community and the County Government to immediately oversee construction of public toilets.

Gateway (facilities-level)

ISSUES

  • Lack of adequate dispensaries for access by residents in need of medical care.

  • Unqualified health personnel administering treatment at the health care centers exposing patients to health risks.

  • Lack of ambulances for use in cases of emergencies, to transport patients to the available health centers for treatment.

  • Unsafe/ unhygienic practices observed while handling food exposing consumers to contracting diseases ie; Cholera.

  • Untreated/ unsafe water distributed to the household for domestic use by the residents exposing them to a variety of ailments.

EFFECTS

  • Poor quality of health care resulting to high mortality cases.

  • High expense incurred in transporting an ailing resident to a health facility depriving some of the much needed treatment.

  • Overdosing and under dosing of drugs leading to negative patient outcomes.

  • High/expensive health care costs proving unaffordable to a number of residents.

SUGGESTED SOLUTIONS

  • Tasking the community, County Government and National Government to take up construction of dispensaries within 2 years.

  • Tasking the community, County Government and the Ministry to immediately ensure qualified medical personnel are stationed at every health facilities and each facility is also registered.

  • Liaise with the community and County Government to ensure ambulances are stationed in the village to respond to emergency cases that may arise.

  • Liaise with the community and the Ministry of health to ensure awareness on food hygiene is immediately conducted within the settlement.

  • Tasking the community and the water company to ensure water distributed to for use is treated and the pipes used are clean and properly installed to facilitate distribution.

 

DIAMOND

ISSUES

  • Unqualified health personnel rendering their services in the health care facilities.

  • High NHIF charges incurred which many at times maybe unaffordable to most residents.

  • Lack of ambulances services to facilitate transportation of ailing residents to the health centers/hospitals.

  • Lack of adequate medicine supply impacting negatively on patient care.

EFFECTS

  • Lack of quality healthcare coverage increasing the mortality cases within the settlement.

  • Poor antenatal care provided and lack of access by some residents leading to increased cases of miscarriage.

  • Poverty and high cost of medical care barring residents form accessing treatment in cases where need arises

  • Overdose of drugs resulting to poor/ negative patient outcomes.

SUGGESTED SOLUTIONS

  • Tasking the County Government, Kenya Red Cross and relevant NGOs to ensure qualified personnel are immediately stationed at the health care facilities.

  • Liaise with County Government, Community and the Ministry of Health to ensure NHIF tariff are reduced to allow affordability.

  • Tasking the community, County Government and the Kenya Red Cross to immediately increase ambulances meant to transport patients to the health care facilities.

  • Tasking the community, County Government, National Government and the Kenya Red Cross to ensure medicines are consistently supplied in health facilities.

 

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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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