SPA consultation recap: health services consortium x Mukuru kwa Njenga segment 3 (Riara), 3.12.2018

Where? a community hall in Riara

When? 3.12.2018

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 3 village Riara; 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:

Health challenges faced by Riara residents were discussed at two levels, the household-level and the hospital-level. Participants discussed their issues, the effects of these issues on the community, and their suggested solutions.

Health in Riara at the household-level

General points made in discussion:

  • Negligence and ignorance- most people in the area tend to ignore their personal hygiene and they do not even care about cleaning their toilets.

  • Water –the water in the area is contaminated hence the drinking water should be boiled and treated this will reduce water borne diseases.

  • Cooking methods- mostly in this area people use stove and jiko which are not clean cooking methods.

  • Poor ventilated houses –houses in the area not properly but with poor ventilated homes most upper respiratory disease are due to this.

  • Drainage –poor drainage system in the area is so poor cause’s water contamination.

  • Garbage collection- garbage collection in this area is poorly done if a garbage collection is introduced that would help in keeping the community clean.

  • Balanced diet – the community should be sensitized on the importance of having a balanced meal.

ISSUES: Pit latrines

EFFECTS: Dirty toilets; Overflowing of faecal matter; Poor spacing: air pollution; Disease like: cholera, diarrhoea

SUGGESTED SOLUTIONS: Sewer lines; Personal hygiene; Public toilets for high population in the area

TIMEFRAME: 6 months–1 year

RESPONSIBILITY: Community; County government

ISSUES: Unbalanced diet

EFFECTS: Diseases like: Kwashiorkor, Marasmus, Anaemia, Rickets

SUGGESTED SOLUTIONS: Sensitization on balanced diet; Eat balanced diet in small portions frequently

TIMEFRAME: Community; Community health workers

RESPONSIBILITY: immediately

ISSUES: Hygiene in the households (Bedbugs, cockroaches, snails and rats)

EFFECTS: Germs, disease respiratory diseases body weakening; Disturbance (rats); Dust in the house

SUGGESTED SOLUTIONS: Maintain personal hygiene; Use pesticides to eradicate the pests; Sensitization on hygiene

TIMEFRAME: immediately

RESPONSIBILITY: community

ISSUES: Garbage dumping (condoms, broken bottles, used syringes)

EFFECTS: Air pollution; Germs through faeces; Risks to health for kids who play with the used condoms

SUGGESTED SOLUTIONS: Dumping sites; Used condoms and sanitary pads should be disposed in the pit latrines; Covering of food in the households

TIMEFRAME: immediately

RESPONSIBILITY: community

ISSUES: Drainage

EFFECTS: Air pollution; Exhausters dump into the drainage; Water stagnation; Mosquitoes; Water pollution; Flooding; Impassable roads

SUGGESTED SOLUTIONS: To open the drainage system; Pest control; Water treatment; Good drainage system

TIMEFRAME: immediately

RESPONSIBILITY: Community; county government

Health in Riara at the hospital-level

General points made in discussion:

  • Distance – the dispensary is far away from the village this causes most villagers to opt for medicine from the chemists in the village.

  • Herbal medicines- most residents of this area when they feel they are sick they buy boiled herbal medicine from medicine men that go around the village.

  • NHIF cards-this card cannot be used in the chemists and clinics in the village, most hospitals that use it prefer cash first the processing of the card takes a lot of time.

  • Quack doctors- most doctors in the area are not qualified doctors they have a little knowledge about medicine they opt  to open chemists and clinics in the slums where they are not licensed

  • Lack of medicines - the dispensary in the area does not have medicines neither the testing equipment’s.

ISSUES: Lack of medicines

EFFECTS: Death; Delayed treatment; Condition worsens

SUGGESTED SOLUTIONS: To reach the ward administrator, the health department; Medicines to be brought frequently to the health centre

TIMEFRAME: immediately

RESPONSIBILITY: Community; County government; Ward administrator.

ISSUES: Lack of enough doctors and nurses

EFFECTS: Death; Condition worsens; Wastage of time

SUGGESTED SOLUTIONS: Increase the number of doctors and nurses

TIMEFRAME: Immediately

RESPONSIBILITY: County government

ISSUES: Lack of equipment

EFFECTS: Delayed medicine supply; Condition worsens; death

SUGGESTED SOLUTIONS: Increase medical equipment’s in public hospitals; The county should visit the health centres to make sure the equipment are available.

TIMEFRAME: 3 months

RESPONSIBILITY: County government

ISSUES: NHIF

EFFECTS: No services without cash money; You will not receive service if not registered to that hospital.

SUGGESTED SOLUTIONS: Nearest hospitals allowed to give NHIF services fully in- patient and out-patient

TIMEFRAME: Immediately

RESPONSIBILITY: County government

ISSUES: Lack of ambulances

EFFECTS: Death

SUGGESTED SOLUTIONS: Provision of enough ambulances

TIMEFRAME: immediately

RESPONSIBILITY: County government


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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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