Health services pre-consultation: Viwandani (all segments)
The Health consortium pre-consultation with Viwandani (residents from segments 1, 2, and 3) was held on 8 November 2018
Where? Sinai Youth Hall, Viwandani, Mukuru
When? Thursday 8 November 2018
What? Health Services consortium Viwandani area pre-consultation meeting (Kenya Medical Association, Kenya Red Cross, Innovative Canadians for Change, Slum Dwellers International-Kenya, University of California Berkley, and Akiba Mashinani Trust)
Who? Resident representatives of SPA Viwandani segments 1, 2 and 3 (villages of Paradise A, Paradise B, Paradise C, Sinai Reli, Sinai Original (segment 1); Jamaica, Lunga Lunga, Milimani (segment 2); Kingstone, Uchumi, Riverside, Lunga Lunga Donholm (segment 3)); representatives from the Health Services consortium; Muungano facilitators.
Aims:
About pre-consultation meetings
In the SPA process, pre-consultation meetings are for a thematic consortium to meet representatives from each of the village clusters into which the planning process has divided the three huge areas that make up the Mukuru slum belt.
Meeting participants are taken through the SPA process, the structure of participation, and a situation analysis relating to the consortium’s sectoral focus. Cluster representatives and community mobilizers are then charged with disseminating this information throughout the sub-clusters for which they are responsible. In addition, village cluster representatives are tasked with overseeing the selection of representatives to sit in the segment-level consultative forums of the consortium.
Pre-consultations help to deepen communities’ understanding of the SPA, as well as dispel rumours or ‘fake news’ being spread by agents opposed to the success of the SPA – since slum communities have many competing interests positioning to capture the benefits of regularization.
They also help a consortium prepare for segment-level consultations – through understanding how their consultation messages are being conveyed by the cluster representatives to their communities, and to hear back the comments, opinions, and questions emanating from their discussions with the community.
Brief notes on the discussion:
About the community consultations
Most consortiums will hold three rounds of community consultations for the SPA process.
The 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 water, sanitation and energy. 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 the second set of meetings, also at segment level, the consortium will seek residents’ feedback on these draft plans, which will then be revised accordingly.
In the third set of meetings, all 8 of the SPA consortiums will together share the final integrated development plan, for adoption by Mukuru’s residents.
The meeting held at Sinai Youth Hall commenced at 10:00am with residents from all the 3 segments in attendance. One of the mobilisers begun by giving an overview of the SPA project and the progress so far as she narrowed down to the key purpose of the day’s meeting.
What are things like now? Findings from a health and health services survey conducted by Mukuru SPA health consortium:
Findings at the settlement-level
Many residents prefer getting health services directly from chemists rather than visiting a hospital.
Nurses, public officers and lab technicians are in most cases the only medical personnel stationed at health facilities in Viwandani.
Most residents seeking health services are outpatient.
Some health institutions perform minor surgeries.
Out of 51 health facilities in Viwandani:
50 are privately owned. Only 1 is government owned.
Only 16 health facilities are registered, out of the available 51 facilities.
Only 6 facilities out of 51 facilities are NHIF compliant.
Findings from the household level
Viwandani households’ most common types of disease are: diarrhoea, fever, headache, coughing, and chest problems.
Most of these health complications are caused by environmental pollution.
Popular ways for most residents access the funds to get medical care include:
Getting medicine on credit from chemists
Loans from Mshwari, Tala and Branch – loans which are direct towards obtaining medical care.
Cutting daily expenditures to save money.
Loans from savings groups.
Borrowing from friends.
Viwandani residents’ ideas, proposals, and suggested solutions that came up in discussion included:
Improving and maintaining sanitation facilities available
Treating water that is meant to be supplied for domestic use.
Re-constructing community drainage systems to combat floods.
Improving services offered at the government hospital.
Discussions about county government health services
County health officers attended the meeting. In discussion, residents were able to air their views on the current status of health facilities in their settlements and the quality/standard of services that are being offered. The county officials committed to relay issues raised by residents to the sub-county health management team for action. Issues raised by residents relating to government health services around Viwandani included:
The existing government health facility is poorly equipped, so patients are frequently referred to other facilities for medical laboratory tests.
Many times patients are only prescribed painkiller medicines on assessment.
It is common knowledge that residents seek health services from chemists because this is easier and convenient for many. Accessing medical care from the existing government health facility is very consuming because there are normally very long queues/wait times.
The available government facility is poorly maintained.
The available government facility lack of sufficient medical supplies.
Reporting: Kamila Karu and Jackie Waithaka. Photos: Muungano KYCTV.
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.