Where? Kingstone

When? 21.11.2018

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? 70 residents representatives from segment 3 villages of Donholm, Riverside, Uchumi and Kingstone; Muungano alliance federation and support professionals; representatives of the Kenya Red Cross.

>What is a segment and how are the consultations organised?

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 (6 in Donholm, 4 in Riverside, 10 in Kingstone, and 1 in Uchimi).

Community participants were also taken through the Kenyan Constitution as it defines requirements for the six levels of health services, ie as follows:

• Community health volunteers (CHVS), meant to cater to 5,000 people

• Dispensaries and clinics, meant to serve 10,000 people

• Health centers, supposed to serve 30,000 people

• Primary health care centres, meant to serve 100,000 people

• Secondary care hospitals, meant to serve one million people

• Tertiary care hospitals, meant to serve 5 million people

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.

DONHOLM

ISSUE: Incompetent health personnel and high medical charges.

EFFECTS: Incompetent personnel offering substandard health care causing a negative effect on patients; Incompetent personnel carrying out wrong diagnosis and issuing wrong medication thus creating serious health consequences on a patient’s health; High medical charges barring patients from seeking health care services in the available health care centers.

SUGGESTED SOLUTION: Stationing qualified doctors and nurses at every health care center.

TIMELINE: Immediately

RESPONSIBILITY: National and county government; Relevant NGO; Community

ISSUE: Hospital equipment

EFFECTS: Usage of unsterilized medical equipment thus transferring infections between patients leading to the rapid transmission of diseases; Uncalibrated equipment being linked to patients’ misdiagnosis

SUGGESTED SOLUTIONS: Adequately equipping the health care facilities.

TIMELINE: Immediately (3 months)

RESPONSIBILITY: National and County government; NGO

ISSUE: Scarcity of drugs

EFFECTS: Increased drug shortages leading to negative impact on patient care.

SUGGESTED SOLUTIONS: Equipping hospitals with enough medication for effective treatment.

TIMELINE: Immediately

RESPONSIBILITY: National and County government; NGO

ISSUE: Transport

EFFECTS: Unavailability of vehicular transport and proper roads suppressing the delivery of quality health care within the settlement.

SUGGESTED SOLUTIONS: Construction of proper road systems to allow easy access into the settlement; Provision of ambulances to facilitate quick response in cases of emergencies. 

TIMELINE: Immediately

RESPONSIBILITY: National and County government; NGO

ISSUE: Poverty

EFFECTS: Financial barriers have been identified as significant obstacles to accessing health services from the available heath care centers.

SUGGESTED SOLUTIONS: Lowering NHIF tariff for easy affordability; Provision of more employment opportunities to make affordability possible.

TIMELINE: Immediately

RESPONSIBILITY: National and County government; NGO

KINGSTONE

ISSUE: Unqualified health personnel

EFFECTS: Incompetent health care providers offering substandard health care leading to negative heath impacts; Issuance of wrong medication to patients creating a major health concern.

SUGGESTED SOLUTIONS: Stationing qualified health personnel in each facility to oversee delivery of quality health care.  

TIMELINE: Immediately

RESPONSIBILITY: Community; Relevant NGO; County government

ISSUE: Poor health facilities offering substandard services

EFFECTS: Issuance of delayed medication causing patients harm; Congestion in hospitals creating a heavy burden in the health sector and unexpected deaths.

SUGGESTED SOLUTIONS: Following up with relevant stakeholders to oversee construction of quality health care centers.

TIMELINE: Short time

RESPONSIBILITY: National and county government

ISSUE: Poor data storage and unsuitable working hours

EFFECTS: loss of medical information compromising accurate patient record-keeping; Inefficient patient care especially during the afterhours leading to negative health outcomes; Administering late treatment causing long term physical effects on patients;

SUGGESTED SOLUTIONS: Setting up a well-integrated working systems within the available hospitals.

TIMELINE: Immediately

RESPONSIBILITY: Community; Relevant NGO; national and county government

RIVERSIDE

ISSUE: Poor community drainage systems

EFFECTS: Lack of proper surface drainage to remove excess water leading to the rapid spread of diseases causing deaths; Poor drainage and sewage systems causing massive flooding within the settlement.

SUGGESTED SOLUTIONS: Construction of proper drainage systems to drain excess surface water.

TIMELINE: Immediately

RESPONSIBILITY: Community; NGO; national and county government

ISSUE: Lack of toilets

EFFECTS: Lack of proper toilet facilities leading to unsanitary living conditions that may contribute to the outbreak of several harmful infectious diseases that may cause death.

SUGGESTED SOLUTIONS: Constriction of additional community sanitation facilities for use by the residents.

TIMELINE: Immediately

RESPONSIBILITY: Community; NGO; national and county government

ISSUE: Unhealthy lifestyle choices

EFFECTS: Poor lifestyle and nutritional choices contributing to the development and progression of diseases.

SUGGESTED SOLUTIONS: Following up with relevant stakeholders to oversee construction of recreation centers for use.

TIMELINE: long term

RESPONSIBILITY: Community; Relevant NGO; national and county government

ISSUE: Lack of clean water

EFFECTS: Inadequate clean and safe water for use at the household level leading to the outbreaks of illnesses associated with unsafe/unclean water

SUGGESTED SOLUTIONS: Provision of clean water for domestic use at the household level.

TIMELINE: Immediately

RESPONSIBILITY: Community; Relevant NGO; national and county government

UCHUMI

ISSUE: Poor drainage systems

EFFECTS: Poorly drained surface water forming stagnant pools that provide breeding sites for diseases and germs; Poor drainage resulting to occasional flooding and displacement of property.

SUGGESTED SOLUTIONS: Constructing proper community drainage systems.

TIMELINE: Immediately

RESPONSIBILITY: Relevant NGO; Community; national and county government

ISSUE: Air pollution

EFFECTS: Long-term exposure to polluted air resulting in significant health problems including: increased respiratory diseases

SUGGESTED SOLUTIONS: Overseeing management of emission of polluted gases into the atmosphere.

TIMELINE: Immediately

RESPONSIBILITY: County and National government

ISSUE: Poor waste management systems

EFFECTS: Bad waste management practices resulting in health complications through the rapid outbreak and spread of diseases

SUGGESTED SOLUTIONS: Zoning a dumping site for proper disposal of community waste

TIMELINE: Immediately

RESPONSIBILITY: Community; County and National government

ISSUE: Sewer lines

EFFECTS: Broken/ leaking sewer lines causing rapid spread of germs and diseases.

SUGGESTED SOLUTIONS: Constructing proper sewer lines to facilitate easy and safe means to dispose waste water.

TIMELINE: Immediately

RESPONSIBILITY: County and National government

ISSUE: Poor nutrition

EFFECTS: Poor nutritional standards and unbalanced diet causing health complications.

SUGGESTED SOLUTIONS: Awareness-creation on the benefits of consuming balanced diet on a daily basis.

TIMELINE: Immediately

RESPONSIBILITY: Community; Relevant NGO; national and county government

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.