Meeting the Health Needs of Marginalized Urban Populations Jane Otai Senior Program Advisor Jhpiego/Kenya [email protected]
Jan 11, 2016
Meeting the Health Needs of Marginalized Urban Populations
Jane Otai
Senior Program Advisor
Jhpiego/Kenya
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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
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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
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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
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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
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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
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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
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Thank You!Thank You!
Asante Sana!!