Meeting the Health Needs of Marginalized Urban Populations

Meeting the Health Needs of Marginalized Urban Populations Jane Otai Senior Program Advisor Jhpiego/Kenya jotai@jhpiego. net

Jhpiego § An affiliate of Johns Hopkins University § For over 35 years in over 150 countries, working to prevent the needless deaths of women and their families 2

Where We Work—January 2009 55 Countries

Jhpiego’s Focus § Working with governments, ministries of health, nongovernmental organizations, universities, professional associations and communities § Building local capacity through performance and quality improvement, system strengthening and strong partnerships § Translating research into practice 4

Urban Landscape 5

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 44 Kenya 31 17 96 77 139 115 69 44 HIV prevalence (males and females) 13. 0 7. 0 Maternal Mortality Ratio (per 100000 live births) 631 414 Children fully vaccinated (%) (Years: all 2003) Children with diarrhea in last 2 weeks (%) Infant mortality rate (per 1000 live births) Under-five mortality rate (per 1000 live births) Post neonatal mortality Rates 57 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 poorlytrained 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

Thank You! Asante Sana!! 18