June 24, 2011 – Healthy schools improve national academic performance
PUPILS WHO STUDY IN SCHOOLS THAT, FOR INSTANCE, PROVIDE WATER AND SOAP ARE MORE LIKELY TO WASH HANDS THAN THOSE IN SCHOOLS THAT DO NOT HAVE THE FACILITIES
NAIROBI (Xinhua) — Schools that promote a healthy learning environment for pupils help to improve their academic performances, a team of researchers has said.
The researchers said such schools, among other things, ensure that the institutions have access to water and sanitation facilities and teachers engage pupils frequently on discussions about health.
This promotes teaching and learning thus increasing student’s chances of excelling in their academics.
The researchers from the Nairobi-based African Population and Health Research Center (APHRC) worked with 22 primary schools in two informal settlements in Nairobi, Kenya under an initiative dubbed Health Promoting Schools ( HPS ).
Sanitation MDG is badly off track, but a community-led approach could fix that
Vast sums are wasted on programmes for free toilets, but the community-led total sanitation approach has helped millions avoid often fatal, faecally related infections.
Community-led total sanitation (CLTS) does not sound such a big deal, but it is revolutionary. We have so many “revolutions” in development that only last a year or two and then fade into history. But this one is different. In all the years I have worked in development this is as thrilling and transformative as anything I have been involved in. Let me explain.
Firstly, sanitation and scale: 2.6 billion people need improved sanitation and 1.1 billion defecate in the open. The millennium development goal (MDG) for sanitation is badly off track in most countries, which affects all the other MDGs.
Secondly, sanitation and hygiene matter much more than most people realise. Where they are lacking, the effects are horrendous. Faecally related infections are many. Everyone feels outrage because more than 2 million children are killed by diarrhoea each year. We hear about cholera outbreaks. But who hears about the guts of 1.5 billion people hosting greedy, parasitic, ascaris worms, about 740 million with hookworm voraciously devouring their blood, 200 million with debilitating schistosomiasis or up to 70 million with liver fluke? And what about dysentery, hepatitis, giardia, tapeworms, typhoid, polio, trachoma…?
May 18, 2011 – Affordable healthcare systems boost safe motherhood for poor
When Zacharia Rombo and Samuel Agutu came together in 2008, the mission was simple — to develop a system that embraces technology to provide affordable healthcare.
This was informed by past experiences in their careers as chartered insurer and accountant respectively.
The result of this union was the birth of Changamka Micro Health Limited, a private company in the business of health insurance that targets the poor.
“It was after realising that not more than 10 per cent of Kenyans are insured under health schemes that we decided to go this way. The purpose was to get the uninsured poor who are the majority in the population, to a position to plan and afford medical care,” says Mr Rombo.
At the beginning, the initial focus was on general healthcare.
However, this has since changed to include safe maternal healthcare targeting 60 per cent of Kenyan women who deliver outside medical facilities.
Today, Changamka Micro Health is known for its popular smart card — the Changamka card — which allows members to save in advance for medical expenses to cover inpatient and outpatient services.
Unlike the common insurance schemes that restrict members to certain amounts of premiums for specified values of medical cover, the smart card allows for flexible contributions.
Glob Public Health. 2011 Apr;6(3)
Discourses of illegality and exclusion: when water access matters.
Mudege NN. African Population and Health Research Center, Shelter Afrique Center, Nairobi, Kenya. email@example.com
This paper examines the politics and the underlying discourses of water provisioning and how residents of Korogocho and Viwandani slum settlements in Nairobi city cope with challenges relating to water access. We use qualitative data from 36 focus group discussions conducted in the two slums to unravel discourses regarding water provisioning in the rapidly growing slum settlements in African cities. Results show that the problems concerning water provisioning within Nairobi slums are less about water scarcity and more about unequal distribution and the marginalisation of slum areas in development plans.
Poor water management, lack of equity-based policies and programmes, and other slum-specific features such as land-tenure systems and insecurity exacerbate water-supply problems within slum areas. It is hard to see how water supply in these communities can improve without the direct and active involvement of the government in infrastructural development and oversight of the water-supply actors. Innovative public-private partnerships in water provision and the harnessing of existing community efforts to improve the water supply would go a long way towards improving the water supply to the rapidly growing urban poor population in Africa.
Kibera, Kenya – Community Turns Garbage Into Energy Source
A community-based organisation in the Kenyan slum area of Kibera set out to clean up garbage and deal with waste water; Ushiriki Wa Safi ended up creating a community cooker that turns waste into an energy source.
Open sewers and piles of garbage are an all too familiar scene in many of Kenya’s poorest urban areas. Local authorities are invisible in most of these slums, and poor public hygiene and the absence of sanitation leaves residents to their own devices to maintain a level of cleanliness and keep diseases like diarrhoea at bay.
But some have seen this as an opportunity to bring about change to communities. Ushirika Wa Safi – (loosely translated, the name means “an association to maintain cleanliness” in Swahili) – a community-based organisation in Kibera, was formed to deal with the garbage problem in Laini Saba, one of the thirteen villages that form Kibera slums, often described as Africa’s largest.
The CBO has come up with a remarkable solution in the form of a community cooker that turns garbage into energy. It is a recycling project that is transforming the lives of local residents.
J Urban Health. 2010 Oct 14.
Food Security and Nutritional Outcomes among Urban Poor Orphans in Nairobi, Kenya.
Kimani-Murage EW, Holding PA, Fotso JC, Ezeh AC, Madise NJ, Kahurani EN, Zulu EM.
African Population and Health Research Center, P.O. Box 10787, 00100, Nairobi, Kenya, firstname.lastname@example.org.
The study examines the relationship between orphanhood status and nutritional status and food security among children living in the rapidly growing and uniquely vulnerable slum settlements in Nairobi, Kenya. The study was conducted between January and June 2007 among children aged 6-14 years, living in informal settlements of Nairobi, Kenya.
JOURNAL OF URBAN HEALTH, Volume 87, Number 5, 879-897, Sept 2010.
Epidemiological Transition and the Double Burden of Disease in Accra, Ghana
Samuel Agyei-Mensah and Ama de-Graft Aikins
It has long been recognized that as societies modernize, they experience significant changes in their patterns of health and disease. Despite rapid modernization across the globe, there are relatively few detailed case studies of changes in health and disease within specific countries especially for sub-Saharan African countries. This paper presents evidence to illustrate the nature and speed of the epidemiological transition in Accra, Ghana’s capital city. As the most urbanized and modernized Ghanaian city, and as the national center of multidisciplinary research since becoming state capital in 1877, Accra constitutes an important case study for understanding the epidemiological transition in African cities.
We review multidisciplinary research on culture, development, health, and disease in Accra since the late nineteenth century, as well as relevant work on Ghana’s socio-economic and demographic changes and burden of chronic disease.
Our review indicates that the epidemiological transition in Accra reflects a protracted polarized model. A “protracted” double burden of infectious and chronic disease constitutes major causes of morbidity and mortality. This double burden is polarized across social class. While wealthy communities experience higher risk of chronic diseases, poor communities experience higher risk of infectious diseases and a double burden of infectious and chronic diseases. Urbanization, urban poverty and globalization are key factors in the transition. We explore the structures and processes of these factors and consider the implications for the epidemiological transition in other African cities.
Urban Margins, Vol 1, Issue 4 2010. OCHA.
Download Full-text (pdf)
Chronic poverty in urban informal settlements (slums) in Kenya is emerging as a critical area of humanitarian need in the country. Urban Margins highlights the humanitarian consequences of urbanization in Kenya. The bulletin also presents current initiatives and strategies to respond to these needs.
- Kenya prepares to address urban disasters
- A mothers quest for a decent meal and life
- Untold stories from life in Kenya slums
- Urban sector dynamics within the new constitutional dispensation
At the recently constructed semi-permanent Canna Medical Centre in Viwandani slums, Nairobi, Grace Nyambonyi and her baby girl Mary, have come for one of their final post-natal visits.
The happy baby plays on her mother’s lap as the latter chats with Penninah Nyamboke, a friend who has accompanied them.
Ms Nyambonyi and Ms Nyamboke are residents of one of the many slums dotting the city, this one being home to approximately 42,000 residents.
Unlike hundreds of other children born in the slums, Mary was not delivered at home under unsafe conditions, thanks to the Safe Motherhood (SMH) voucher that covered the delivery costs at the health centre.
Ms Nyambonyi is one among hundreds of women in Kenya who have benefited from donor supported programs that have successfully boosted health care provision to the poor.
The government is now duplicating such models in developing health financing policy and designing strategies for facilities through performance based funding.
Ms Nyambonyi’s voucher, purchased for Sh200 under the Output Based Approach (OBA) pilot program — a Kenya Government initiative supported by the German Financial Cooperation, Kfw — has given her access to free pre and post-natal clinic visits at a health centre of her choice throughout her pregnancy.
Emergency expenses such as complications and referrals to larger hospitals are also catered for under the program.
The expectant mothers also receive food rations consisting of seven kilograms of corn soya and a litre of cooking oil at each visits courtesy of the World Food Program, to help them at a time when they are not able to work.
“This program has been very helpful because we deliver safely, complications are treated quickly and our babies are healthy” said Ms Nyambonyi.
She was allowed to purchase the voucher after staff hired by the Voucher Management Agency (VMA) – a private firm that manages this program — visited her house and gave her a chance to carry her pregnancy to term and deliver safely under a skilled health official, reducing the risk of complications that sometimes results in a lifetime of infections and even death.
“When mothers deliver at home, screening for HIV cannot be done, use of unsterilized implements leads to infection and birth notification forms are not available” said Mr Joseph Mambo, Director at Canna Medical Centre.
Ms Nyambonyi also has to certify on claim forms that are processed by VMA that she received satisfactory service before payment is made to the health facility — something new in the provision of health services.
Under a Kfw supported pilot project and similar UNICEF supported program in North Eastern Province, the low cost of the vouchers has led to increased health facility deliveries and uptake of family planning methods, an indication that high costs hinder the poor from accessing health care.
There has also been behavioural change with more women choosing to go to hospital for treatment of other ailments.
Am J Prev Med. 2010 Jul;39(1):78-80.
Mobile direct observation treatment for tuberculosis patients: a technical feasibility pilot using mobile phones in Nairobi, Kenya.
Hoffman JA, Cunningham JR, Suleh AJ, Sundsmo A, Dekker D, Vago F, Munly K, Igonya EK, Hunt-Glassman J.
Danya International, Ltd., Silver Spring, Maryland, USA.
BACKGROUND: Growth in mobile phone penetration has created new opportunities to reach and improve care to underserved, at-risk populations including those with tuberculosis (TB) or HIV/AIDS.
PURPOSE: This paper summarizes a proof-of-concept pilot designed to provide remote Mobile Direct Observation of Treatment (MDOT) for TB patients. The MDOT model combines Clinic with Community DOT through the use of mobile phone video capture and transmission, alleviating the travel burden for patients and health professionals.
METHODS: Three healthcare professionals along with 13 patients and their treatment supporters were recruited from the Mbagathi District Hospital in Nairobi, Kenya. Treatment supporters were asked to take daily videos of the patient swallowing their medications. Patients submitted the videos for review by the health professionals and were asked to view motivational and educational TB text (SMS) and video health messages. Surveys were conducted at intake, 15 days, and 30 days. Data were collected in 2008 and analyzed in 2009.
RESULTS: All three health professionals and 11 patients completed the trial. All agreed that MDOT was a viable option, and eight patients preferred MDOT to clinic DOT or DOT through visiting Community Health Workers.
CONCLUSIONS: MDOT is technically feasible. Both patients and health professionals appear empowered by the ability to communicate with each other and appear receptive to remote MDOT and health messaging over mobile. Further research should be conducted to evaluate whether MDOT (1) improves medication adherence, (2) is cost effective, and (3) can be used to improve treatment compliance for other diseases such as AIDS.