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 ).
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. firstname.lastname@example.org
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.
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, email@example.com.
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.
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 Trop Med Hyg. 2009 Nov;81(5):770-5.
Seasonal pattern of pneumonia mortality among under-five children in Nairobi’s informal settlements.
Ye Y, Zulu E, Mutisya M, Orindi B, Emina J, Kyobutungi C. African Population and Health Research CenterAPHRC, Nairobi, Kenya. firstname.lastname@example.org
Using longitudinal data from the Nairobi Urban and Demographic Surveillance System (NUHDSS), we examined the seasonal pattern of pneumonia mortality among under-five children living in Nairobi’s slums. We included 17,787 under-five children resident in the NUHDSS from January 1, 2003 to December 31, 2005 in the analysis. Four hundred thirty-six deaths were observed and cause of death was ascertained by verbal autopsy for 377 of these deaths. Using Poisson regression, we modeled the quarterly mortality risk for pneumonia. The overall person-years (PYs) were 21,804 giving a mortality rate of 20.1 per 1,000 PYs in the study population.
Pneumonia was the leading cause of death contributing 25.7% of the total deaths. Pneumonia mortality was highest in the second quarter (risk ratio [RR] = 2.3, confidence interval [CI]: 1.2-4.2 compared with the fourth quarter). The study provides evidence that pneumonia-related mortality among under-fives in Nairobi’s slums is higher from April to June corresponding to the rainy season and the beginning of the cold season.
Trop Med Int Health. 2009 Nov 2.
Is mortality among under-five children in Nairobi slums seasonal?
Mutisya M, Orindi B, Emina J, Zulu E, Ye Y. African Population and Health Research Center, Nairobi, Kenya.
Objective: To investigate the seasonal pattern of overall mortality among children aged below 5 years living in two informal settlements in Nairobi City.
Methods: We used data collected from January 2003 to December 2005 in the Nairobi Urban Health and Demographic Surveillance System on demographic events (birth, death, and migration). Analyses of seasonal effects on under-five mortality are based on Poisson regression controlling for sex, age, study site and calendar year.
Results: During the study period, there were 17 878 children below 5 years in the study sites. Overall 436 under-five deaths were recorded. The overall death rate for the under-five children was 19.95 per 1 000 person years. There is a significant seasonal variation of under-five mortality. The mortality risk was significantly higher in the second and third quarters of year than in the fourth quarter (RR = 1.6, CI: 1.3-2.2 and RR = 1.5, CI: 1.1-2.0).
Conclusion: This paper demonstrates that overall mortality among under-five children in the urban poor is seasonal. Overall during the second quarter of the year, the death rate increases by nearly twofold. This evidence generated here may help to support well targeted interventions in reducing under-five mortality in the slums.
There is no malaria in Nairobi, say experts – City residents may have been taking expensive malaria drugs for years when the disease is negligible, if not non-existent, in Nairobi.
Research carried out in 2008 by reputable organisations indicates there is no malaria in the city. The firms that conducted the study include the Kenya Medical Research Institute, the UK’s Oxford and Southampton universities, London School of Tropical Medicine and the African Population and Health Research Centre in Nairobi.
Despite evidence that there could be no malaria in Nairobi, patients especially children with fever were treated for the disease and with the wrong drugs in most instances, says the study, which was prepared for an international conference on health.
Some 983 people in Korogocho, Nairobi were tested and only three indicated they could be having the parasite. Further testing, however, found them to be negative.
“Microscopic examination showed zero prevalence,” says the study titled Malaria Infection in an Urban Informal Settlement in Nairobi: A myth or reality.
Of the group, 170 had run a fever in the last 14 days with more than half being treated for malaria with drugs that are not recommended by the government.
“Only four cases were treated using the recommended first-line treatment,” says the study. The findings contradict the perception of a rising incidence of malaria in Nairobi attributed to warm climate that is more habitable for mosquitoes that carry the disease.
If the findings are validated, malaria may be one problem less to worry about for people in Nairobi. However a more emerging and potent threat will be outlined at the conference on Thursday.
Mr J. O. Ogendo of Maseno University says the biggest danger to city residents, after muggers and robbers, are road accidents targeting pedestrians and cyclists. The researcher recommends that city planners consider pedestrian-friendly policies for Nairobi.
Urban Poverty and Vulnerability In Kenya: Background analysis for the preparation of an Oxfam GB Urban Programme focused on Nairobi. Sept. 2009. OXFAM. (pdf, full-text)
This urban poverty analysis by Oxfam GB was informed by the fact that urban poverty emerged as a key challenge in the OGB Kenya 2007 National Change Strategy review. A range of international actors as well as the government of Kenya now acknowledge the urbanisation of poverty in the country and the scale of the challenges presented by rapid urbanisation. From an Oxfam perspective, this means recognising the need to invest further resources in urban work in a country where, until recently, the programme has focused principally on emergency response and the arid lands in the North in recent years.
Urban poverty and inequality in Kenya
This report brings together the growing evidence about the scale and nature of poverty in Kenya’s urban areas. Between a third and half of the country’s urban population live in poverty, and given the pace of urbanisation, urban poverty will represent almost half of the total poverty in Kenya by 2020. Moreover, while urban poverty has been decreasing according to some measures, statistics indicate that the proportion of the urban population that are poorest of all (the ‘food poor’ and ‘hardcore poor’) has been on the rise.
In Nairobi, the capital city, 60% of the population live in slums and levels of inequality are dangerously high, with negative implications for both human security and economic development. Feelings of insecurity in many of the city’s informal settlements have heightened considerably since the violence following the contested election results of December 2007. Poverty in the city is worst amongst those with low levels of education, another cause for concern given that considerably fewer children attend the later stages of school in Nairobi than in Kenya’s rural areas, and many slum areas have few or no public schools. Meanwhile gender inequalities remain severe, with female slum-dwellers being 5 times more likely to be unemployed than males.
Rainwater Harvesting Seen as Solution for Drought and Flood Control
NAIROBI – Bitter irony: in recent years Nairobi has experienced severe flooding and widespread water shortages, due to poor urban planning and collapsing infrastructure systems that are failing to support the Kenyan capital’s expanding population.
Large parts of the city are not properly served by water and sanitation infrastructure, particularly crowded areas like the Eastlands estates of Umoja, Makongeni and Doholm but also wealthier enclaves such as Karen and Langata.
At the same time, the rapid expansion of the city has led to sealing off of large surface areas, increasing the speed and volume of storm water run-off. Furious flooding exposes and damages water pipelines and chokes drainage channels with debris, spilling raw sewage into the streets.
David Mburu, chair of the Kenya Rainwater Association, says because there is too much surface cover, rain water is prevented from percolating into the ground. Some city residents who have opted for boreholes as an alternative to the intermittent water supply are now experiencing inadequate yields.
Mburu says there is a need to encourage both the harvesting of rainwater from buildings and directing run-off water into system of drains that would recharge the groundwater levels.
“Not all this water should be harvested and stored since we also need to recharge our groundwater levels by encouraging use of construction material that allows for seeping of run-off water into the ground or leaving as much surface that allows infiltration of water as possible,” he says.
Peris Otachi, a resident of Kayole Estate, lost a brother in the 2001 floods, the worst experienced in Nairobi in recent years. “Flooding in Nairobi has become an annual ritual which unfortunately is never addressed by the city council or the government despite causing deaths and massive destruction.”
Eleven people were killed by floods in Nairobi in 2001; while police cannot confirm the exact numbers, at least 21 more people have been drowned in flood waters since then. Otachi, whose younger brother’s body was only found on the banks of the Nairobi River four days later, is now among residents who strongly believe that the floods can be controlled and the rainwater made better use of.
“It all starts with demystifying the rainwater harvesting technology,” says Mr Stephen Mutoro.”Let the people know it is within their reach to do it and its for their benefit in that they would reduce their water bills and access adequate water for non-potable use.” Mutoro is the Executive Secretary of the Kenya Water and Sanitation Network (KWSN), a water consumers’ lobby group based in Nairobi.
“We need to create methods to capture rainwater as surface water is inadequate to meet demand in congested, over-paved metropolitan cities,” says Professor Shaukat Abdulrazak, executive secretary of the National Council of Science and Technology.
A government statutory institute, the Council supports simple but effective rainwater harvesting methods as a solution to the over-paved city verandahs and streets. These include the installation of gutters to capture the roof water and setting up of underground storage tanks, especially by those putting up new homes and buildings.
How to get the process under way is a matter of some debate. Officials from the newly-created Nairobi Metropolitan Development (NMD) ministry, a new management structure for the greater Nairobi area, say rain water harvesting is to be enhanced to address the twin issue of flooding and water scarcity in the city of three million people, 75 percent of whom live in water-scarce slum and low income areas.
“We want to enhance effective rain water harvesting under an investment framework for water and sewerage services in the proposed metropolitan area in addition to managing metropolis’s water resource management capacity,” NMD minister Mutula Kilonzo promised during the launch of the draft on the proposed metropolis by President Kibaki in January 2008.
The minister said that the government would seek the enactment of a legal framework to regulate rainwater harvesting, but some stakeholders in the water sector have expressed reservations over proposals contained in the NMD’s establishing document, Nairobi Metro 2030, a 423 billion dollar blueprint on the future expansion and improvement of Nairobi city and its environs.
It’s not a question of denying the need for new regulations. Some existing legislation is an impediment to the implementation of the technology.
Mburu from the Rainwater Association points to current city bylaws as an example. “They have not incorporated rainwater harvesting and the existing infrastructure does not support the kind of technology we are talking about. But maybe within a given time frame the law may be changed for example to make it a requirement that all buildings provide for groundwater storage, gutters and roof storage.”
But the KWSN’s Mutoro says managing the problem of urban flooding in Kenya need not wait for a new legal framework, which experience has shown could take a long time. Instead, he urges campaigns to woo people to embrace the technology should be intensified.
“The government can make recommendations on the kind of roofing that is needed for every new house coming up in the city and give owners of the existing houses specified time within which they install rain water harvesting facilities but making it mandatory may not be the best way forward,” Mutoro suggests.
Let the city dwellers see the advantages of harvesting rainwater, he says “and when they compare the amount of money they are likely to save through using the stored rain water with that which they are paying the Nairobi Water and Sewerage Company for treated water every month there is no doubt they will embrace this technology.”
However, he says tax rebates on materials for setting up a rainwater harvesting system may be necessary when one considers the low income bracket water consumers.
Early in 2008, President Kibaki and former finance minister Amos Kimunya promised Kenyans the National Water Harvesting and Storage Policy Bill would be passed by Parliament before the end of the year.
But a crowded legislative agenda, dominated by debate and passage of crucial governance laws as recommended by two commissions appointed to investigate the bungled 2007 general election and post-election violence dragged on and by the time the legislators were breaking for their recess in December, the proposed Bill had not been tabled in Parliament. It is hoped that the new Bill would be brought to Parliament once the next session commences sometime in June.
Water and Irrigation assistant minister Mwangi Kiunjuri says the soonest the Bill can be brought to Parliament is August 2009.
“Parliament has proceeded on recess and the parliamentary year is over. And when we come back we will embark on budget debate, so the earliest it may come is August or thereafter,” Kiunjuri said.
Until new systems are put in place, the city will be suffering unnecessarily. The United Nations Environmental Programme (UNEP) estimates that Nairobi has a potential to harvest almost ten million cubic meters of water each year, if rainwater harvesting measures were in place in all the city’s rooftops, roads, open grounds and forest-covered areas.
A survey report by UNEP, “Potential for Rain Water Harvesting in Ten African Cities”, shows that Kenya’s capital has the potential to supply the water needs of between six and 10 million people “with 60 litres a day if rainwater were efficiently and effectively harvested.”
“The rainfall contribution is more than adequate to meet the needs of the current population several times over and Kenya for example, would not be categorized as a ‘water stressed country’ if rainwater harvesting is considered,” the UNEP survey report adds.