By Tabitha Wakesho and Evans Otibine, Akiba Mashinani Trust

This post is one in a series that the Muungano Alliance will publish throughout 2021 about the ongoing Mukuru Special Planning Area (SPA) process—with particular focus on the transition from planning to implementation. Each post provides an update on a specific aspect of the Mukuru SPA and reflects on challenges faced and the associated lessons we have drawn thus far from the process.

In this post, we report on the strides achieved in implementing some aspects of the Mukuru integrated development plan that relate to access to health services. 

We all need access to primary healthcare. In urban poor settings, addressing healthcare disparities is one of the biggest challenges in implementing primary healthcare improvements.

In Mukuru, Nairobi, the Muungano Alliance (in particular Muungano Wa Wanavijiji and Akiba Mashinani Trust (AMT)) have partnered with Access Afya to create a new medical fund that will increase the accessibility and affordability of quality health services for residents living in the settlement.

Background: Mukuru’s healthcare situation

Mukuru faces so many public health challenges from unsafe physical infrastructure and inadequate service provision. Residents’ health and wellbeing are compromised daily by improper solid waste disposal, sewer outbursts, inadequate toilet facilities and industrial pollution. As much as it needs access to quality and affordable healthcare, this community also urgently needs the underlying challenges to good health to be addressed.

Despite the dire need for good quality state-run health services, the special planning area in Mukuru has only three state-supported health facilities serving a population of around 400,000 people and growing. Because three health facilities is clearly woefully inadequate, unregistered clinics and pharmacies have thrived. These unregulated facilities often pose a threat to the lives and health of those they serve. But formal (regulated) private facilities are usually too expensive for access to be a reality for Mukuru’s residents.

Seeking a solution to address these challenges, the Muungano Alliance have partnered with Access Afya—a social enterprise that delivers primary healthcare to the poorest communities in Kenya—on a healthcare programme currently being piloted in Mukuru. The partnership is to create a medical fund that will increase the accessibility and affordability of good quality health services for people living in the Mukuru SPA.

Access Afya

Access Afya has eight clinics, three pharmacies and one fully equipped laboratory that provide health services to people in the Nairobi informal settlements of Mukuru, Mathare and Kiambiu. Access Afya clinics are known for their affordable prices when compared to services offered by other clinics—and affordability goes a long way to helping low income urban residents to access medical care.

“As a community health volunteer, I have interacted with many sick families and referred them to seek medication from an Access Afya clinic in Mukuru Kwa Njenga. Most people I refer to the clinic are women and children. For example, women are happy with the ultrasound services offered at the clinic because they are good quality and pocket-friendly: an ultrasound costs KES 1,000 [about US$10] in Access Afya clinics, compared to KES 2,500 in other hospitals. The affordability of the services attracts women from as far as Athi River, because they only have to spending KES 50 bus fare to reach Mukuru and the [cheaper] Access Afya medical services.”

— Annie Njoki, Community Health Volunteer from Mukuru Kwa Njenga

Access Afya medical products

Access Afya has developed two medical products: a family fund and an individual fund.

The family medical fund caters to all registered members of a household. To qualify for this service each household must make a minimum deposit of KES 6,000 per year to an Access Afya clinic of their choice. Every time a registered family member falls ill and seeks treatment, the clinic draws down their payment from the amount deposited, until treatment is completed. When the deposit fund is depleted, the family must replenish its account.

With the second product, an individual pays a non-refundable KES 1,500 per year for unlimited visits to the health facility.

Both funds cover doctor’s consultation fees, laboratory tests and medication, and registered members also benefit from free health talks and screening services.

AMT medical fund

Most members of Muungano wa Wanavijiji, the Kenyan federation of slum dwellers, organise themselves through savings groups and savings schemes. These community-based collectives are an ideal structure for financing healthcare for the benefit of members and their families. AMT has established a new fund that provides short-term loans to members of Muungano saving schemes who are keen to access the services provided by Access Afya, but can’t afford to pay the upfront fees in one go.

Once a savings group has applied for a loan for its members and paid a 20% cash collateral to AMT, a loan facility equivalent to 100% of the total cost of the medical product chosen is provided. The loan is paid back to AMT over time, in small instalments through the saving scheme.

Each beneficiary is issued a unique, branded Muungano/Access Afya medical card. And in consultation with Access Afya, AMT send beneficiaries statements about using the fund and their balances.

Progress so far

As at December 2020, the healthcare programme has been piloted in two clinics in Mukuru, in Viwandani and Mukuru kwa Njenga.

A lot of preparatory work was done before the programme launched. There were initial meetings with AMT and Access Afya staff to agree the terms of health products to be offered. Three workshops were held to train Muungano community mobilisers on the agreed terms and scope of the new health products and the available financing options. The trained mobilisers were tasked with sensitising and recruiting groups to take up the medical products. They reached out to existing saving schemes, sensitised members about Access Afya Services and helped interested people fill in application forms for the new medical products.

As an entry point and to ensure ease of uptake, selection criteria were designed and savings schemes that had already benefited from AMT livelihood loans were recruited first.

AMT digitised the data collected from applicants and sent a database to Access Afya, which then printed medical cards for each applicant. By the end of 2020, a first pilot cohort of 165 individuals and/or households had been recruited.

We’ll report again as the pilot progresses.