Meeting the Health Needs of Marginalized Urban Populations

Jane Otai

Senior Program Advisor

Jhpiego/Kenya

jotai@jhpiego.net

2

Jhpiego

An affiliate of JohnsHopkins University

For over 35 years in over 150 countries, working to prevent the needless deaths of women and their families

Where We Work—January 2009

55 Countries

4

Jhpiego’s Focus

Working with governments, ministries of health, non-governmental organizations, universities, professional associations and communities

Building local capacity through performance and quality improvement, system strengtheningand strong partnerships

Translating research into practice

5

Urban Landscape

Thinking about Urban Health

Why urban? Why now? How is urban health different from rural health? What exactly is Jhpiego doing in urban health? What resources are available? What has been achieved so far? How can you help?

Facts about Urban Context

Most urban growth is in informal settlements, or slums 1/3 of urbanites live in slums

(=~1.2 billion) 72% of African urbanites are

slum dwellers. Africa is the fastest urbanizing continent

Asia has the largest number of slum dwellers

– 554 million total– 60% of all slum dwellers

worldwide

Challenges affecting health in Urban Slums

Proximity does not equal access to health care

Low quality of health care

Low utilization of formal health services

Lack of roads, water, sanitation

Over crowding

Unemployment, crime and poverty

8

Selected Health and Demographic Indicators for Nairobi Slums and Kenya

Indicator Nairobi Slums

Kenya

Children fully vaccinated (%) (Years: all 2003)

44 57

Children with diarrhea in last 2 weeks (%)

31 17

Infant mortality rate (per 1000 live births)

96 77

Under-five mortality rate (per 1000 live births)

139 115

Post neonatal mortality Rates 69 44HIV prevalence (males and females)

13.0 7.0

Maternal Mortality Ratio (per 100000 live births)

631 414

Data source: APHRC, KAIS 2007 and KDHS 2003

Innovative Community Problem Solving

What works in the urban slums context Not: “We the experts will

identify gaps and create a plan”

Rather: “What are your needs? What solutions will work for you?”

– Health facility level– Community level

Leads to: empowerment, ownership & sustainability

Urban Community Attitudes

Lack of trust in health facilities Afraid of services being offered Consider health providers rude,

discriminatory and not understanding Strong cultural and religious beliefs Health facility is “where you go to die”

Health Facility Gaps Untrained or poorly-trained

personnel Not well equipped

Often lack supplies and commodities

Lack basic amenities Running water, toilets or

incinerators

High demand for few providers Inadequate infrastructure Facilities in disrepair Poor provider attitudes

Health Facility Interventions

Training of health providers Building health providers’

capacity to be able to train others

Equipping health facilities Exchange visits between health

facilities Outreaches and linkages with

communities Support Groups for health

providers

Community Interventions

Community mapping of “rape hot-spots” and available health services

Paralegal training on rights Self defense “I'm Worth Defending” Training community on what quality health services

entail Police training in post rape management Support groups Training in income generating activities

The Community & Clinic Come Together

Health provider empowered Better trained Improved facilities Motivated, supported

Community empowered Able to make informed

health decisions Better access to health

information Able to defend themselves

15

Selected Program Results

268 community health workers trained on health issues

438 community leaders trained on various health issues

Over 50,000 people reached through community activities

Community maps Community directory

16

How can you help?

Share the message that urban health is the challenge of the future in the developing world, especially in Africa and Asia

Advocate for resources for integrated urban health programming

Support expansion of urban health programs in Kenya and beyond, including smaller cities which are growing fast

18

Thank You!Thank You!

Asante Sana!!