KENYA: Healthcare hurdles in Nairobi’s slums

Quality healthcare is a luxury often beyond the reach of those who live in Nairobi’s slums, such as mother-of-seven Grace Awour Opondo.

"When you are sick you buy medicine from the local shops," Opondo told IRIN. "If you are lucky you recover because the medicine is not usually the right one.

"Sometimes there is no medicine even in the hospitals, so they send you out with a prescription," she said. "Then the chemists are expensive so often one has to make do without the medicine."

According to Sakwa Mwangala, a programme manager with the African Medical and Research Foundation (AMREF), the fact that people are squatting on government land often prevents them from accessing essential services. Slums are regarded as informal illegal settlements, which means they are underserved in terms of infrastructure development and access to basic amenities.

"Government health facilities are also not easily accessible for most slum residents," said Mwangala, who heads AMREF's Kibera integrated healthcare programme. Kibera, on the southwestern edge of central Nairobi, is one of the largest and most densely populated slums in sub-Saharan Africa.

Most people operating health “facilities” in the slums are quacks, he said. “There is a lack of quality control, with the people in most of these clinics lacking skills."

The urban poor fare worse than their rural counterparts on most health indicators, according to a report, Profiling the burden of disease on the residents of Nairobi slums prepared by the African Population and Health Research Center (APHRC).

Pneumonia, diarrhoeal diseases and stillbirths account for more than half the deaths of children under-five, while HIV/AIDS, tuberculosis, interpersonal violence injuries and road traffic accidents account for more than two-thirds of deaths among people aged five years and older, stated the report.

The poor health status of slum children is in part due to continuous exposure to environmental hazards coupled with a lack of basic amenities.

"The chances of one becoming sick are high because of the poor sanitation; most of the houses are also poorly ventilated," according to Leonard Wawire, a teacher in the Mathare slum.

"Here, there are no trees to clean the air; any plant growing is usually growing out of waste," Wawire said.

Prevention measures

Eliya Zulu, APHRC’s deputy director of research, told IRIN it was important to adopt a holistic approach to healthcare for the urban poor, one that focused as much on prevention – through improved nutrition and immunisation against major childhood diseases – as on treatment.
“Increasingly, most people in the urban areas are living in deplorable conditions yet it is generally assumed that the better hospitals and schools are in the urban areas,” Zulu said.

When conducting general health surveys, urban areas tend to rank better than rural areas in terms of the health indicators. This, however, failed to bring into focus the health situation of the urban poor, he said.

The problems of the urban poor have often been overlooked while rural areas are seen as more vulnerable to shocks.

"In the rural set-up there is a sense of normalcy; you can have your toilet, the community also has a stream from which they draw their water - this is not the case in the slums," Mwangala of AMREF said.

Many deaths in the slums are caused by preventable and treatable conditions, according to the APHRC report; inadequate sanitation encourages the spread of skin and waterborne diseases.

In a bid to improve sanitation in Kibera, a Kenyan NGO, the Umande Trust, is running a project that not only provides quality toilets for residents but also transforms human waste into biogas and liquid fertiliser.

Residents in areas such as Katwekera and Laini Saba in Kibera, pay two shillings (three US cents) to use the toilets and showers, according to Josiah Omotto of the Trust. For a subscription of 80 shillings ($1.19) a month, households get unlimited access to the facility.

The buildings’ basements house bio-digester domes, which turn human waste into methane and liquid fertiliser.
According to Omotto, these help reduce the local use of firewood. Already, he said, the methane from the facility in Laini Saba was being used for fuel by a local nursery school. There are plans to construct similar facilities in other slums to supply the gas to residents living near the facilities.

So far, at least 500 residents are benefiting from each facility.

The division of environmental health in Kenya's Ministry of Health is finalising policy documents aimed at ensuring that 90 percent of households have access to, and make use of, hygienic, affordable, functional and sustainable toilet and hand-washing facilities.

The policies also aim at reducing the national rate of preventable sanitation-related diseases by half.

IRIN