Urban Margins, Vol 1, Issue 4 2010. OCHA.
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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.
Most maternity medical centres in Nairobi are no more than death traps, lacking in facilities, medicines and human skills.
A study carried out by the Nairobi-based African Population and Health Research Centre, the World Bank and two UK universities — Southampton and Liverpool John Moores — found high maternal deaths related to poor medical services.
In a study published in the Journal of Reproductive Health, the researchers surveyed 25 health centres in Korogocho, Viwandani and surrounding areas and found that not only were medicines, human skills and equipment lacking, but these centres are not supervised by any government authority.
NAIROBI, Kenya, Aug 2 – With just one day to go to the Constitution referendum, a new report by a human rights watchdog shows that 92 percent of women in Kenyan slums have procured an abortion at least once in their lifetime.
The report by the Kenya Human Rights Commission (KHRC) comes at a time when the Constitution debate has reached its peak with the church opposing the proposed Constitution over the abortion clause.
“Despite the fact that the respondents were exposed to high risks of complications, most of them did not bother to undergo a follow up in a hospital,” KHRC Acting Deputy Executive Director Tom Kagwe said on Monday.
Mr Kagwe said 80 percent of the abortions were through perforation of the cervix to induce premature labour, 15 percent used herbs while the other five percent used medical personnel.
“Whether or not the debate on abortion will inform people (on the way to vote in the referendum) it is clear that even before 4th of August unsafe abortion has been procured and even after that people will still secure unsafe abortion countrywide,” he said.
The study was done among 65 women between March and April last year in Korogocho slums.
Maternal mortality in the informal settlements of Nairobi city: what do we know?
Ziraba, Abdhalah Kasiira, Nyovani, Madise, Samuel, Mills, Catherine, Kyobutungi and Alex, Ezeh. (2009) Reproductive Health, 6, (6)
Background: current estimates of maternal mortality ratios in Kenya are at least as high as 560 deaths per 100,000 live births. Given the pervasive poverty and lack of quality health services in slum areas, the maternal mortality situation in this setting can only be expected to be worse. With a functioning health care system, most maternal deaths are avoidable if complications are identified early. A major challenge to effective monitoring of maternal mortality in developing countries is the lack of reliable data since vital registration systems are either non-existent or under-utilized. In this paper, we estimated the burden and identified causes of maternal mortality in two slums of Nairobi City, Kenya.
Methods: we used data from verbal autopsy interviews conducted on nearly all female deaths aged 15–49 years between January 2003 and December 2005 in two slum communities covered by the Nairobi Urban Health and Demographic Surveillance System (NUHDSS). In describing the distribution of maternal deaths by cause, we examined maternal and late maternal deaths according to the ICD-10 classification. Additionally we used data from a survey of health care facilities that serve residents living in the surveillance areas for 2004–2005 to examine causes of maternal death.
Results: the maternal mortality ratio for the two Nairobi slums, for the period January 2003 to December 2005, was 706 maternal deaths per 100,000 live births. The major causes of maternal death were: abortion complications, hemorrhage, sepsis, eclampsia, and ruptured uterus. Only 21% of the 29 maternal deaths delivered or aborted with assistance of a health professional. The verbal autopsy tool seems to capture more abortion related deaths compared to health care facility records. Additionally, there were 22 late maternal deaths (maternal deaths between 42 days and one year of pregnancy termination) most of which were due to HIV/AIDS and anemia.
Conclusion: maternal mortality ratio is high in the slum population of Nairobi City. The Demographic Surveillance System and verbal autopsy tool may provide the much needed data on maternal mortality and its causes in developing countries. There is urgent need to address the burden of unwanted pregnancies and unsafe abortions among the urban poor. There is also need to strengthen access to HIV services alongside maternal health services since HIV/AIDS is becoming a major indirect cause of maternal deaths
Kenya: Insecurity and indignity: Women’s experiences in the slums of Nairobi, Kenya, 2010.
More than half the residents of Nairobi live in informal settlements and slums. Their housing is inadequate and they have little access to clean water, health care and other essential public services. Violence against women is widespread where ineffective policing results in rape and other violence against women going largely unpunished.
This report examines the experiences of women living in four slums in Nairobi. It calls on the Kenyan government to address gender-based violence against women and to ensure women’s access to sanitation and public security services.