Public Services Leave Nairobi’s Poor Worse Off

Imagine:

60% of Nairobi’s 3 million residents live in informal or unplanned settlements, often derogatorily referred to as slums, even in official government literature. In almost all situations, the informal settlements are completely devoid of public services. This scenario is replicated in nearly all major Kenyan towns such as Mombasa, Kisumu, Nakuru , Eldoret, and Nyeri. Provision of critical public services has been left to the informal ‘private’ sector and community based organizations, such as the Sinai Health Clinic and Resource Centre depicted in the photo above.  Many of the facilities are poorly equipped, poorly staffed with unqualified personnel, and lack basic supplies. Many of the facilities are indeed not licensed and therefore operating illegally.

In the case of health care services, there is no functioning or coordinated primary health care system, no system or chance of referral in the event of an emergency and no competent public or private pharmacies to administer medications. Much of the curative and health promotion services are undertaken and sponsored foreign funded nongovernmental organizations. The resulting statics are grim:

• 10% of births in informal settlements are handled by traditional birth attendants (TBA’s). The TBA’s have no formal training and certainly no skill to handle complications in pregnancy. As a matter of fact, the current National Reproductive Health Policy bars them from delivering women. The prevalence of TBA’s in informal settlements, is a pointer to a larger problem, the lack of essential and appropriate maternal and reproductive health services accessible to the poor in the informal settlements.

• 85% of all providers of ante-natal health services in informal settlements charge for this service. The charges can range from US$ 2 to US$4 for a laboratory investigation.  Virtually 100% will charge for delivery with an average price of US$ 22 for a normal delivery to US$390 for a caesarean section.

• While 70% of women in Nairobi’s informal settlements will deliver at a health facility, only 48% of those do so at a facility that meets the minimum standards set by the Ministry of Health. A whole 52% of women who sought and paid for critical maternal health services were therefore attended by unqualified staff at sub-standard facilities.

• At 706 deaths per 100,000 live births, maternal death rates in informal settlements are significantly higher than the national average at 560 per 1000,000. In other words, more women die at childbirth in informal settlements than in the rural areas or other planned urban settlements.

• The leading causes of maternal deaths in the informal settlements can be easily avoided or managed. These include complications from abortion, bleeding after delivery, infection after or during delivery, high blood pressure during pregnancy and HIV/AIDS.

A similar trend is discernible in regard to food security and nutrition where food security is pervasive in Nairobi’s informal settlements.

• Over 60% of Nairobi’s residents must be content with having just one meal a day. This meal hardly has all the nutritional requirements needed to keep one healthy.

• Only one in five households in Nairobi’s informal settlements is food secure with 50% of all households being categorised as food insecure.

• Adult and child hunger is prevalent with parents in informal settlements routinely foregoing food in order to feed their children.

• While majority of children are clearly vulnerable to food insecurity orphans will experience this more severely than non-orphans. Among these paternal orphans will more vulnerable than maternal ones, while orphaned boys are more vulnerable than orphaned girls.

• Children living in the poorest households, households  headed by females, households with many dependents and households where the head has minimal or no education are more vulnerable than others.

In education, a survey of 7,475 primary school aged children showed that 40% of children from the poorest households in informal settlements attend non-public schools. This is in contrast to 34% of children of the richest households in the informal settlements. In other words, free public education still excluded the poorest of the poor as better off households in informal settlements are better represented in public schools. Virtually all the public schools serving the informal settlements are located outside these settlements.  Most of the ‘private’ schools serving the poor in informal settlements are likely to be understaffed, staffed by untrained teachers and administrators, set on a few rooms, lacking critical learning materials and informal in nature usually run by an unincorporated community based organization.

Another example involving a critical service, water and sanitation, demonstrates the clear connection between residents ill health and the lack of public services.

• 91% of residents of Langas, one of Nairobi’s informal settlements, use wells as the main source of water for domestic consumption. The other 9% uses tap water. Now over 70% of this population is dependent on pit latrines for excreta disposal. Owing to the close proximity of the wells and the latrines;

• 100% of water from check site seo
  shallow   wells in the community was contaminated with faecal matter. Of the two deep wells, two also tested positive for faecal matter. The water from these wells was positive for pathogen that is tolerant to heat indicating that it had originated from the pit latrines.

• 0% of the samples from the taps tested positive for faecal matter.

• It follows that 97% of residents in Langas were dependent on water that was unsafe for human consumption. Clearly lack of an appropriate sanitation and water service was eating away at the health of this community. A simple well designed sanitation facility and an extension of the piped water service was all that was needed.

The lack of services in Kenya’s informal settlements is a deep running structural issue. Historically the problem can be traced to the founding of the urban centres with firm residential racial segregation by the colonial authorities. This was achieved through demarcation of spatially segregated settlements for Europeans, Asians, Arabs and Africans. The segregation was put in place via planning laws and exclusionary zoning regulations that partitioned Nairobi into quarters for each race with the African quarter being the smallest. In addition the government restricted large scale development of public housing in large part to keep Africans out of the city.

With independence, urban racial segregation was rapidly replaced by a new economic or class based segregation in which the new African economic elite and civil service moved into the quarters previously reserved for the other races. While racial colonial state policies drove segregation before independence, ‘market forces’ and governmental connivance took over and perfected it after independence. As a result only Africans who achieved a measure of economic success were able to set themselves up in Nairobi’s planned settlements. While initially you were not free to live where you wished, now you could not overcome this obstacle without sufficient economic means.

Often, in between the planned settlements were large tracts of reserved land. Some of this was designated railways and forest reserve. Some land was reserved for future planned settlement while more other land was located on river valleys. In Nairobi some informal settlement was encouraged in Kibra (Kibera) when a large number of Nubian’s who served with the British in the second world war were allowed to squat on a section of Ngong Forest.  With the increasing urban migration, more and more migrants choose to settle on this ‘free’ land.

Since the state does not recognise these informal settlements, they have routinely been bypassed and effectively denied in the design of public services, state planning and budgeting processes through which public resources are allocated. The structural nature of the challenge and the embedding of these settlements to Nairobi’s industrial and commercial economy combine to throw up many policy initiatives to these problems.

As a consequence, residents of these informal settlements have been left to their own devices in responding to the clear need for public services. The combination of demand for services, informal non-state providers, and the presence of an external donor ‘market’ has fed a growing social economy of ill equipped service providers and underprivileged marginal consumers.  Many residents have founded welfare organizations, community based organizations and found other coping mechanisms that together make a plethora of informal institutions to respond to the challenges thrown at them by this lack of public services. Many residents have also set up thriving informal enterprises to supply to this demand.

It is estimated that 50% of Kenyans will be living in its urban areas as soon as 2025. 60% of these are likely to do so in informal settlements.  The question remains, how to end the historical and structural neglect and denial of services by the state of the residents of Kenya’s informal settlements.