Kenya – 90% of Nairobi’s poor get wrong medication

Poor residents of Nairobi have turned to self-medication, with 90 per cent of them getting inappropriate drugs and wrong dosages.

A new report by the Kenya Medical Research Institute (Kemri) blames the Pharmacy and Poisons Board for the alarming trend, accusing it of laxity in enforcing rules.

“Because of the high cost of health services, the urban poor have turned to the neighbourhood retail pharmacy for self- medication which is aggravating drug resistance and fuelling infections,” says the study, published in the September issue of the East African Medical Journal that was distributed last month.

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The team, led by Kemri researcher Zachary Kwena, did an in-depth study in Nairobi’s Kibera slums and found that only 10 out of 100 people are getting the recommended drugs for gonorrhoea and genital ulcer disease.

“In fact only nine out of fifty pharmacy attendants offered the recommended treatment for gonorrhoea and only one individual offered the right treatment for genital ulcer disease,” says the study.

The researchers said they investigated gonorrhoea and genital ulcer disease to get a picture of medicine use among the poor in Nairobi. In this scenario, say the researchers, the pharmacies are putting Kenyans at a greater risk of aggravating an existing disease and an increased opportunity for infecting others.

“Most of the pharmacy staff offered drugs that were not recommended for present conditions and unfortunately even those who offered the correct medicine did not give the right dosage, frequency or duration,” says the study.

This, it concludes, points to a serious problem that could lead to resistance and treatment failures. They are also concerned that the habit is contributing to the high rates of HIV prevalence found in most slum settlements. “This is fuelling the HIV pandemic since the management of sexually transmitted infections as an HIV prevention tool is well documented.”

In a medical commentary over the study, Dr Bill Lore of the International Network for the Rational Use of Drugs, says there is total anarchy in the country’s health care system and blames the Pharmacy and Poisons Board for laxity and the Medical Practitioners and Dentists Board for not punishing errant members.

He says the decay spreads across the whole city and cited an earlier study which surveyed 34 pharmacies in the city centre and 90 in peri-urban centres. The study found 64 per cent of the pharmacies selling antibiotics without prescriptions and most of the drugs were under-dosed.

Profit margins

In December, the World Health Organisation said the majority of Kenyans cannot afford essential medicines mainly because of unreasonably high profit margins being enjoyed by manufacturers.

In a study involving 36 developing and middle-income countries, including Kenya, WHO says manufacturers are making mark-ups of more than 380 per cent and those made by retailers were more than 550 per cent.

It urged governments to intervene. A government survey done in 2007 said more than 60 per cent of Kenyans can hardly afford essential drugs and have to stay without treatment.

The Pharmaceutical Society of Kenya chairman, Dr Dominic Karanja, blames the free market economy. “There are no controls since it is a free market, therefore, everyone sets their own mark-ups according to demand,” he said.

Source – Daily Nation

WSP – Empowering Urban Areas to Better Manage Water Supply and Sanitation

Empowering Urban Areas to Better Manage Water Supply and Sanitation, 2009 (pdf, full-text)

Dar Es Salaam, February 19, 2009—The Water and Sanitation Program today released a practical course manual for trainers of urban communities in Tanzania to improve water supply and sanitation management practices.

The seven modules are meant to equip communities with the tools to eliminate or reduce the major constraints in managing infrastructure and providing services. The manual also clarifies the roles and responsibilities of all stakeholders.

“Experience shows that communities who show ownership of their water supply and sanitation demonstrate a more vested interest in its maintenance and sustainability,” said Wambui Gichuri, Regional Team Leader for Africa at the Water and Sanitation Program (WSP). “This manual will allow trainers to teach communities how to do this better, and will serve as a reference tool for those communities for years to come.”

The manual was developed in collaboration with the Dar es Salaam Water and Sewerage Authority’s (DAWASA) Community Water Supply and Sanitation Program (CWSSP), but some material is applicable to other urban communities who may need to improve their management practices and increase the likelihood of a sustainable operation.

“The manual can also be a way for Government, planners, donors, and other supporters of these programs to better understand the nuances involved in rendering these services more sustainable,” Ms. Gichuri said.

The manual covers technical issues such as operations and maintenance activities—but also has a strong focus on institutional, managerial, and financial issues. The material is especially relevant for communities who have a relationship with the main water services provider and who are also committed to hiring an Operations Manager. The Operations Manager, the report says, should be a paid employee and their performance should be reviewed by beneficiaries.

Africa cities failing on green targets

Major Cities in Africa are grappling with monumental challenges that are placing hurdles in the move towards green economy.

Rapid industrialization and population growth in these Cities has constrained the ability to cope with high levels of air and water pollution, hence the slow pace in greening these cities.

A panel of experts roundtable held at the ongoing UNEP Governing Council meeting in Nairobi noted that Cities are critical in catalyzing the move towards low carbon economy in Africa.

However, this can only be made possible through increased investments, development of sound policies and political goodwill, required to raise the bar in limiting greenhouse gas emissions in Africa’s burgeoning cities.

Angela Cropper, UNEP Deputy Executive Director noted that Cities presents huge potential in realization of green goals among African Countries” if only authorities move urgently to tackle basic challenges revolving around poor infrastructure, high levels of pollution and overstretched capacity of basic amenities such as water and sanitation to meet growing population.”

She reiterated that Cities are the next frontier for greening the planet and Africa must capture this opportunity by scaling up efforts that would add impetus on the move towards low carbon economy. Cropper observed that one half of the total global population live in Cities.

“African Cities are the new frontiers for industrial growth in the light of influx of rural population that have moved to the cities in search of better livelihoods.”

She says As a result, informal settlements have mushroomed in these Cities. Poor urban planning and poverty has created setbacks in efforts to restore ecological health in the Cities.

For Cities in Africa to attain green goals, greater efforts must be devoted towards improved solid and liquid waste management, as well as construction of ecofriendly low cost houses, says. CropperCities emit 75% of carbon dioxide in the atmosphere.

In Africa, Cities are responsible for atmospheric pollution whose ripple effects are being felt in the rural areas as evidenced by rising health and ecological disasters.

Africa governments must therefore invest in innovative but less costly technologies to curb greenhouse gas emissions in major Cities; this is according to Sylvie Lemmet, Director, UNEP Division for Technology, Industry and Economics Lemmet contends that African Cities can be transformed to boost their capacity in greening the economy.

“This can be realized through engaging the citizens, private sector and civic authorities in the application of green technologies while developing physical infrastructure such as housing, energy, water and sanitation”.

She said mutual partnership among these key stakeholders can assist in development of low cost houses fitted with solar panels. “Ecosanitation projects, recycling of liquid and solid waste are critical in development of renewable energy in these cities”, she says.

The Mayor of Entebbe, Stephen Kabuye reiterated that Africa Cities can provide the required impetus to green the Countries` economies.

“This can be realized through prudent use of natural resources to meet the demand on the population and maintain ecological balance”, he says.

Kabuye notes that high population growth has exerted pressure on Lake Victoria natural resources and is as well responsible for pollution on the Worlds second largest fresh water body. “Uganda government has therefore imposed a ban on illegal fishing in the lake”, says Kabuye.

The government of Uganda is assisting communities living in cities and Municipalities adjacent to Lake Victoria to implement pollution control programmes.

“The government is encouraging energy efficiency by helping communities acquire energy saving stoves to minimize firewood use. Other measures include promotion of renewable energy such as solar and wind”, says Kabuye.

Recycling of solid and liquid waste at the local level to curb pollution is being encouraged. Entebbe Municipality is promoting use of broken bottles in security fences. Cattle, fish bones and food peelings are being used to manufacture animal feed, he adds.

Source – Africa Science News

Clinton visits USAID sponsored toilet projects in Indonesia

US Secretary of State Hillary Rodham Clinton visited on Thursday a toilet-provision project sponsored by the US Agency for International Development (USAID) in Petojo Utara in Central Jakarta as part of her two-day visit to Indonesia.

Tempointeraktif.com reported Clinton arrived at the subdistrict after she had met with President Susilo Bambang Yudhoyono.

During a press conference at the neighborhood Junior High School 38, Clinton said she had planned this brief visit as part of her people-to-people approach to diplomacy.

“Through this kind of interaction, I can find out what the public feels and can encourage them to better their quality of live,” she said.

At 1:30 p.m., she left the subdistrict and headed to Halim Perdanakusuma airport to continue on with her official trips to South Korea and China.

Source – Jakarta Post

Kenya – Lifestyle diseases catch up on Kenya’s urban poor

Harry Ndara, a father of three and diabetic for the last 10 years, stares forlornly at the prospects of yet another bleak dawn, occasioned by lingering doubts on whether a ray of hope looms anywhere in the horizon.

Ndara has also lived with High Blood Pressure for the last two years.

Africa Science News Service crew caught up with him at a Diabetic Clinic sponsored by Africa Population and Health Research Canter (APHRC) and Provide International.

The Clinic is offering free treatment on diabetes and high blood pressure to a people who cannot afford and would otherwise succumb to the ailments

Ndara and his sick neighbours can afford a smile, at least for now as nongovernmental agencies attend to their plight by providing free treatment to terminal ailments, which have aggravated the level of their deprivation.

The middle-aged casual labourer is a resident of Korogocho slums, a sprawling habitat to an estimated quarter of a million people, which is located in the eastern fringes of Nairobi City.

Korogocho slums have epitomized abject poverty and other forms of deprivation rampant in Nairobi’s informal settlements.

Here, access to basic amenities is a nightmare. Basic infrastructure such as roads, electricity, water and sewerage has either broken down or is nonexistent.

Korogocho residents have been forced to live with communicable diseases such as Chorela, Typhoid and Dysentery due to poor sanitation. Access to clean piped water remains a pipedream to majority of residents.

The grim statistics on heavy toll of communicable diseases in Korogocho and other poorer suburbs in Nairobi have however prompted some action at higher levels.

This is evidenced by far reaching intervention programmes the Ministry of Public Health and Sanitation in conjunction with other partners, have initiated to curb spread of these epidemics among the vulnerable populations in the slums and rural areas.

Not so to lifestyle diseases, whose dramatic surge is opening new frontiers to demographic groups rarely associated with them.

According to World Health Organization (WHO), an estimated 240 million people globally are diabetic and are expected to hit 400 million by 2025.

Kenya records a 12% rate of prevalence in diabetes.

Catherine Kyobutungi, an Associate Research Scientist at Africa Population and Health Research Canter (APHRC), gave a grim portrait on high incidences of diabetes, cardiovascular diseases and cancers, which are being recorded among poorer segment of the population.

She told Africa Science News Service that poor dietary habits, alcoholism, stress and environmental pollution are contributing to high rate of diabetes, heart diseases and cancers among the poor in Nairobi’s informal settlement.

“The magnitude of the problem is huge despite little awareness. Policymakers have paid scant attention on rising cases of lifestyle diseases among the poor on the premise that they are confined to affluent members of the society”, she says.

Kenya is yet to compile a data on extent of lifestyle diseases and this has placed hurdles in development of a comprehensive policy on them, says Kyobutungi

The Africa Population and Health Research Canter in conjunction with Provide International are implementing a cardiovascular disease programme targeting Korogocho and Viwandani slums.

The project seeks to evaluate the extent of cardiovascular as well as diabetes incidents in these informal settlements and has targeted five thousand people, says Kyobutungi

A random survey identified seven hundred cases.

“Random sampling in Korogocho and Viwandani indicates that one in seven people aged eighteen years and above are either diabetic or hypertensive”, says Kyobutungi.

Management and treatment on these lifestyle diseases is a costly affair more so to slum residents who subsist on a dollar per day.

Kyobutungi says that the cost of insulin is high. Thirty vials of insulin that are used in every clinic sell at Kshs 500 and Kshs 1500 in public and private hospitals respectively.

Most patients visiting Korogocho and Viwandani Clinics have type one and two diabetes.

APHRC and other partners are offering free drugs alongside accurate information to boost patients capacity in self management of the disease, says Kyobutungi.

Source – Africa Science News

India – Urban Health Meeting Organised by PATH in Mumbai

Urban Health Meeting Organised by PATH in Mumbai

Launched in November 2005, ‘Sure Start’ is a five-year project, initiated across UP and Maharashtra

‘Sure Start’, an initiative by Programme for Appropriate Technology in Health (PATH), working to improve maternal and newborn health in Maharashtra, jointly held an urban health meet with the Public Health Department, Government of Maharashtra (GoM). The meet was a result of continuous discussions held between GoM and PATH in the wake of the National Urban Health Mission (NUHM) that is on the anvil and was organised with a view to share ground experiences and learnings till date from the ‘Sure Start’ project.

The participants included senior health officials from the State Government. Public Health Department (PHD), Directorate of Health Services (DHS), State Family Welfare Bureau (SFWB), Municipal Commissioners, Medical Officers of Health (MOH) and RCH officers of all the 22 municipal corporations. Apart from this, with PATH the implementing NGO lead partners of the Sure Start programme also attended the meet.

Launched in November 2005, ‘Sure Start’ is a five-year project, initiated across seven districts of Uttar Pradesh in the rural areas and in select urban slums in seven cities across Maharashtra. The project team has been working with an objective to significantly increase individual, household and community action that directly and indirectly improve maternal and newborn health.

The programme aims at enhancing systems and institutional capabilities for sustained improvement in maternal and newborn care and health status. The team monitors and tracks the progress of interventions in order to assess the progress and success of the program in bringing about the desired behavior change.

Anjali Nayyar, MS Country Director, PATH while welcoming all present at the meet said, “PATH programmes worldwide are based on the key premise that simple practices can have a profound impact on the health status of communities and especially the vulnerable ones. The ‘Sure Start’ programme in UP and Maharashtra will help us learn about implementing strategies to reduce maternal and newborn deaths and improve their health. In the long-run, the project would complement and support the GOI’s commitment to improving maternal and newborn health and nutrition with a special focus on the RCH II and upcoming NUHM.”

In Maharashtra, ‘Sure Start’ supports a range of innovative pilot activities being carried out in urban slums, intended to develop models that may be replicated across cities elsewhere in the future.

There are seven programme models being followed, each of them focus on strengthening the health system and clinical care by working on four key intervention levels. This includes community mobilisation, increasing demand and facilitation of an enabling environment, building household awareness in essential maternal and newborn care and nutrition including recognition of danger signs and appropriate care seeking, appropriate referral, facilitating access to institutional deliveries and skilled attendance at birth and lastly strengthening of linkages between communities and the public and private healthcare systems.

The GoM is looking at ‘Sure Start’ as a model, which will provide key learnings for the upcoming NUHM. Next month the municipal corporation officials from other cities will be visiting ‘Sure Start’ cities and project sites to have an on ground experience of the work being done in these areas. PATH has also been invited by GoM to be a part of the task force on urban health in the state.

Link – http://www.expresshealthcaremgmt.com/200902/market27.shtm

IIED – The Urban Resource Centre, Karachi

The Urban Resource Centre, Karachi: The roles of local organisations in poverty reduction and environmental management, 2008 (pdf, 542KB) by Arif Hasan.

The Urban Resource Centre is a Karachi-based NGO founded by teachers, professionals, students, activists and community organisations from low-income settlements. It was set up in response to the recognition that the planning process for Karachi did not serve the interests of low- and lower-middle-income groups, small businesses and informal sector operators and was also creating adverse environmental and socioeconomic impacts. The Urban Resource Centre has sought to change this through creating an information base about Karachi’s development on which everyone can draw; also through research and analysis of government plans (and their implications for Karachi’s citizens), advocacy, mobilisation of communities, and drawing key government staff into discussions. This has created a network of professionals and activists from civil society and government agencies who understand planning issues from the perspective of these communities and other less powerful interest groups. This network has successfully challenged many government plans that are ineffective, over-expensive and anti-poor and has promoted alternatives. It shows how the questioning of government plans in an informed manner by a large number of interest groups, community organisations, NGOs, academics, political parties and the media can force the government to listen and to make modifications to its plans, projects and investments. Comparable urban resource centres have also been set up in other cities in Pakistan and also in other nations.

India – ‘Urban poor not an overspill of rural poverty’

NEW DELHI, Feb. 9: Urban poverty in India is not an overflow of the poverty in villages but result of “poorly planned” urbanisation, according to the country’s first-of-its-kind report on urban poverty.

The United Nations Development Programme (UNDP) sponsored study said an estimated 23.7 per cent urban populace was living in slums amid squalor, crime, disease and tension, but not all slum dwellers exist below the poverty line. Poor city planning and poorer urban land management and laws are to be blamed for the rise in numbers of urban poor, revealed the India:Urban Poverty Report, 2009, released at a function here by the Union minister of housing and urban poverty alleviation, Ms Kumari Selja.

Urban poverty, the report said, was not about only nutritional deficiency but deficiencies in the basic needs of housing, water, sanitation, medical care, education, and opportunity for income generation. “It is not a report on the poor in urban areas but a report on the process of urbanisation in India keeping poverty at the centre of analysis,” said social scientist Prof. Amitabh Kundu, who has played a key role in bringing out the report.

The report revealed that urban workers were being increasingly pushed into the informal sector and the urban poor were a street vendor, a rickshaw puller, a rag picker, a cleaner, a washerman, a load carrier or a domestic servant.

The report that deals in detail with the problem of small and medium cities, said while these workers contributed to the growth of cities, there was a growing trend to push them to the urban periphery. A near absence of rights to land and livelihood, and the higher cost that the poor have to incur on transportation and travel to workplace are some of the highlights of the study.

Quoting latest data from National Sample Survey (NSS), it said it would be dangerous to let the process of urbanisation and migration be centred on a few mega cities, ignoring smaller towns.

The NSS data suggests that poverty in large cities, particularly in metros, was rather low, at or below 10 per cent. Towns with less than 50,000 people, on the other hand, have much higher level of poverty and greater deprivation and the quality of their lives was almost similar to that in rural areas.

Source – The Statesman

USAID/ESP – Drinking water treatment alternatives, Jakarta

Action Research on Point-of-Use Drinking Water Treatment Alternatives as Appropriate for Underprivileged Households in Jakarta. October. 2008. USAID Environmental Services Program (ESP). (pdf, 3MB)

This report documents the action research conducted on point-of-use drinking water treatment alternatives appropriate for underprivileged households in Jakarta. An introduction to the scope of work and project summary is first given. Second, technology research is covered, specifically boiling, isi-ulang, chlorination, ceramic filtration, and SODIS, which are each discussed with regards to background, technology, perception, and limitations. A preliminary comparison of these disinfection technologies follows. Next reported are results from bench-scale investigations of SODIS and ceramic filtration, which were conducted prior to implementing alternative practices with community members.

Pilot-trials with Bintaro Lama, Bintaro Baru, Teluk Gong, and Tanjung Priok slum communities in Jakarta followed. A Water Handling & Hygiene Campaign, and subsequent Point-of-Use Water Treatment Alternatives Campaign, was initially conducted in each of these four communities. Campaign participants ranked their treatment preferences at that time, and thereafter, volunteers to try one of each of the treatment alternatives were assigned in each of the communities. Water quality was monitored and user feedback was documented from the 20 families participating over the following month.

A User’s Feedback & Water Quality Results Campaign was then conducted in each community, where each user spoke about their findings and water quality results were presented. Campaign participants ranked their treatment preferences again at that time. Conclusions were made based on all the information gathered and analyzed to assess the technology comparison method constructed and implemented and to provide grounded advice for feasible replication.

Nigeria – The water vendors, BBC News

Isa earns a hard living pushing a heavy water cart around the rutted streets of the suburbs of Nigeria’s capital, Abuja.

He is one of tens of thousands of water vendors who deliver jerry cans full of water to houses built without any kind of sanitation.

“Kai! it is hard work, pushing my cart,” the 20-year-old says.

Nigeria is Africa’s most populous nation, and according to analysts has made over $1.1 trillion in revenues from the oil industry over the last 30 years; but most Nigerians still rely on people like Isa for their water.

He and a dozen of his friends sleep in a makeshift shelter behind a small household goods shop.

They wake before dawn to queue up at a nearby borehole, where they fill 14 yellow 25-litre jerry cans on their handcarts before setting off around the streets looking for customers.

Heavy load

Fully loaded, the carts weigh at least 350kgs.

The roads they push them over are dirt tracks, rocky and pitted, with sewers running down the middle.

“In the future I want to get another job, but at least I make enough money to live doing this,” Isa says.
The urban poor pay more for water than the urban rich

Prices for water from private boreholes vary in the suburbs.

Isa pays around 10 naira ($0.07, £0.05) per jerry can at the borehole and sells for double that.

He makes around 700 naira a day ($4.70, £3.20), to cover food and living costs.

A large Nigerian family may need around 10 of these jerry-cans every day, customers say.

That adds up to about $486 (£339) every year, a massive pressure on a country where the average person lives on $2 a day.

This is a pattern repeated around the world, according to the UN Development Programme.

The urban poor in developing world cities including Abuja pay much more for their water than citizens of rich cities such as New York or Tokyo, precisely because the poor have to depend on private providers rather a piped municipal supply.

Government failure

Virtually none of the suburbs of Nigeria’s capital city have what is known here as “pipe-born water” provided by the government.

Private individuals have to drill boreholes for themselves.

They are most often fitted with two sets of taps – one for the household, and another facing the street so the owners can make a bit of money on the side.

John, a 25-year-old borehole manager, says the place he looks after in Nyanya Gwandara earns his boss 7,000 naira ($47, £32) a day.
We cannot wait for the government to do anything, we are relying on other wealthy people to dig boreholes.

“The man is from Kogi State where he lives, far away. He dug several boreholes in this area for an investment,” he says.

His customers are grateful.

“We cannot wait for the government to do anything, we are relying on other wealthy people to dig boreholes,” says Janet Daniels, who lives in the area.

She cannot afford to buy the water from the delivery boys, so comes every morning to the borehole to save money.

She fills two 20-litre buckets every morning and carries them on her head back to her home.

“I have to boil the water that we drink because its a very shallow borehole, and sometimes its got little particles of stuff in it.”

Otherwise the quality of the water from here is ok, she says.

Husseini, another water vendor working at a borehole in Nyanya Gwandara, says people like the water from this hole, and he even charges more for it on his rounds.

Scummy rivulets

But other water vendors try and find free sources of water like streams and ponds.

These scummy rivulets are often fed by the sewer-streams that run through the middle of the streets. Diseases like polio, cholera and other types of gastric infection disproportionately affect those in poverty, who get water from bad streams.

Abuja, like other cities in Nigeria, is rapidly growing.

The government has fallen so far behind in providing water here, it may never catch up.

Over the last year the price of a jerry-can of water has doubled.

These problems will only get more acute, and the price of water will only go up.

Source – BBC News