tag:theconversation.com,2011:/us/topics/nairobi-slums-25540/articlesNairobi slums – The Conversation2023-08-06T08:48:25Ztag:theconversation.com,2011:article/2100022023-08-06T08:48:25Z2023-08-06T08:48:25ZLiving in Nairobi’s slums is tough – residents are 35% more likely to suffer from high blood pressure than those in rural areas<figure><img src="https://images.theconversation.com/files/540442/original/file-20230801-29-5f1zo2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Slum-dwellers with high blood pressure struggle to get proper treatment</span> <span class="attribution"><span class="source">AlexanderXXI/Shutterstock</span></span></figcaption></figure><p>Hypertension, commonly referred to as high blood pressure, is a non-communicable disease that occurs when there is a sustained elevation in the pressure of the blood that flows through the arteries. </p>
<p>Adults in low- and middle-income countries account for around <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4979614/">75%</a> of the global cases. </p>
<p>High blood pressure is a manageable condition through regular monitoring, lifestyle changes and treatment. However, untreated blood pressure, also known as uncontrolled hypertension, can lead to damage to organs such as the kidneys, heart and brain. All this increases the risk for heart attack, stroke and other serious health issues.</p>
<p>Globally, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6964205/">uncontrolled hypertension</a> is a leading contributor to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5388856/">death</a>. </p>
<p>In Kenya, the 2014-2015 <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-6052-y">national survey on non-communicable diseases</a> showed that high blood pressure contributed to a significant burden of disease. About <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-6052-y">one in four people</a> have high blood pressure in the country. The hypertension prevalence for <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-6052-y">Kenya (24.5%)</a> is slightly lower than that of neighbouring countries such as <a href="https://web.archive.org/web/20220401033113/http://www.who.int/ncds/surveillance/steps/UR_Tanzania_2012_STEPS_Report.pdf#page=48">Tanzania (26%)</a> and <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0138991">Uganda (26.4%)</a>.</p>
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Read more:
<a href="https://theconversation.com/hypertension-diabetes-stroke-they-kill-more-people-than-infectious-diseases-and-should-get-a-global-fund-195479">Hypertension, diabetes, stroke: they kill more people than infectious diseases and should get a Global Fund</a>
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<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8883228/">Research</a> suggests that urban slum residents are 35% more likely to be hypertensive than people living in rural areas. In Nairobi, Kenya’s capital city, around <a href="https://unhabitat.org/sites/default/files/2020/09/un-habitat_and_the_kenya_slum_upgrading_programme_-_strategy_document.pdf#page=12">60% of the population</a> lives in slums or slum-like conditions. <a href="https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-015-0112-1">Previous</a> <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-2610-8">research</a> in <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-14-1177">Kenya’s urban slums</a> shows high uncontrolled hypertension rates. </p>
<p>In our <a href="https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0001625">recent study</a>, my colleagues and I wanted to understand the range of factors that put these people at risk for uncontrolled hypertension or protects them from it. </p>
<p>We found that the low socio-economic status of the slum residents, coupled with high medication prices, limited treatment. </p>
<h2>Gaps in care persist in urban areas</h2>
<p>Nairobi’s slum dwellers experience sub-optimal access to essential services. They face conditions that make informal settlements vulnerable to emergencies such as disease outbreaks and natural disasters. </p>
<p>Even though there are effective treatments for hypertension, gaps in care persist in urban areas in Kenya, particularly among the poorest communities.</p>
<p>Our research aimed at understanding the barriers to blood pressure control at various levels – individual, family and community, health system and policy. </p>
<p>We collected data through interviews and focus groups in two Nairobi slums: Korogocho and Viwandani. We interviewed people who had uncontrolled hypertension, aiming to understand their experiences and perspectives about their care. </p>
<p>Healthcare providers were interviewed to gather information about their prescription practices, adherence to national guidelines and knowledge of hypertension. </p>
<p>We also interviewed decision-makers and policymakers to gain their views on the challenges faced in getting hypertension care in the study community. </p>
<p>The research identified barriers to blood pressure control across all the levels studied. Major bottlenecks were the high cost of hypertension medicines, the constant unavailability of medicines at health facilities, and an unsupportive family and environment.</p>
<p>In this <a href="https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0001625">study</a>, access to medication was a major barrier to blood pressure control.</p>
<p>Countries such as <a href="https://jhpn.biomedcentral.com/articles/10.1186/s41043-017-0090-4">Eritrea</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2830110/">South Africa</a> provide free hypertension medications at the community level.</p>
<p>In Kenya, however, free medication is provided only at higher-level health facilities. Slum residents have access to lower-level facilities which are not mandated to provide hypertension medications. </p>
<h2>So what can be done?</h2>
<p>A viable approach is to implement programmes with interventions capable of addressing the complex array of factors influencing hypertension care. </p>
<p>For instance, the provision of free or subsidised medicines would remove barriers that hinder patients’ access to hypertension medication. </p>
<p>It’s also essential to implement policies and directives to ensure equitable care for all, including those in slum communities seeking care at lower-level health facilities.</p><img src="https://counter.theconversation.com/content/210002/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Shukri F. Mohamed does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Hypertension is a manageable condition – but left untreated, it can damage organs such as the kidneys, heart and brain.Shukri F. Mohamed, Associate Research Scientist, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1921492022-11-16T14:35:47Z2022-11-16T14:35:47ZEducation in Kenya’s informal settlements can work better if parents get involved – here’s how<figure><img src="https://images.theconversation.com/files/494689/original/file-20221110-13-iiqx2x.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Anthony Asael/Art in All of Us via Getty Images</span></span></figcaption></figure><p>Education is a public good. All children should have access to education as a human right, irrespective of their gender, socioeconomic or disability status. </p>
<p>This is reinforced and validated by countries’ commitment to <a href="https://iite.unesco.org/publications/education-2030-incheon-declaration-framework-action-towards-inclusive-equitable-quality-education-lifelong-learning/">Sustainable Development Goal 4</a>. Its promise is inclusive and equitable education, and lifelong learning for all children. </p>
<p>This right is not assured, however. About <a href="https://www.unicef.org/turkiye/en/press-releases/more-104-million-children-and-young-people-1-3-are-out-school-countries-affected-war">303 million</a> children and adolescents aged between five and 17 are out of school. </p>
<p>Research studies have underscored that parental involvement and empowerment make a difference to student education outcomes and well-being. There are <a href="https://www.proquest.com/openview/9e3a9e802f80705150dceec414b8ed1c/1?pq-origsite=gscholar&cbl=41842">five ways</a> in which parents can improve students’ schooling outcomes: </p>
<ul>
<li><p>meeting basic parental obligations</p></li>
<li><p>family involvement in the home</p></li>
<li><p>exchange and collaboration at the community level</p></li>
<li><p>active communication between teachers and parents</p></li>
<li><p>opportunities for parents to offer their services in school as volunteers. </p></li>
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<p>Over the past nine years, my research through the <a href="https://aphrc.org/wp-content/uploads/2020/01/Advancing-Learning-outcomes-brief.pdf">Advancing Learning Outcomes for Transformational Change</a> (A LOT Change) programme in Kenya has shown that when parents get involved, students’ academic and psychosocial attributes improve.</p>
<p>This study – which ran from 2013 to 2022 in Nairobi – has shown that parents are enablers, motivators and facilitators of their children’s education at all levels of schooling. This runs from the early years, through the provision of <a href="https://gh.bmj.com/content/bmjgh/6/4/e004436.full.pdf">nurturing care</a>, to the completion of the basic education cycle. </p>
<h2>The research</h2>
<p>To establish the impact of parents’ involvement in adolescent lives, the African Population and Health Research Center implemented the A LOT Change programme in Korogocho and Viwandani in Nairobi, Kenya. Korogocho and Viwandani are informal settlements.</p>
<p>The community-based programme was implemented among adolescent girls between 2013 and 2015, and between girls and boys in primary school from 2016 to 2018. A cohort of secondary school students was followed from primary school between 2019 and 2022. </p>
<p>The programme provided after-school support and mentorship in life skills. It also provided school transition subsidies, and exposed parents to guidance and counselling to support their adolescents’ schooling. It further gave girls and boys opportunities to enhance their leadership skills through training and motivational talks. </p>
<p>ALOT Change sought to secure the future of children in urban informal settlements by improving learning outcomes, leadership skills and social behaviour. It also aimed to improve the transition rate for girls and boys aged 12 to 19 to secondary school. </p>
<p>The initiative was informed by the realisation that teachers – and schools in general – cannot do it all. They need the support of parents and communities to effectively nurture the educational aspirations of adolescents. </p>
<h2>Findings on the importance of parents</h2>
<p>A LOT Change initiatives improved parental involvement in children’s education. This included encouraging parents to actively communicate with their children, provide homework support and follow up on academic performance. Parents also got to know who their children associated with, or their whereabouts if the children weren’t home. </p>
<p><strong>Enhanced communication between parents and adolescents:</strong> Parents who participated in the programme noted that establishing <a href="https://aphrc.org/publication/advancing-learning-outcomes-and-leadership-skills-among-children-living-in-informal-settlements-of-nairobi-through-community-participation-2/">open communication channels</a> bridged the generation gap between them and their children. This made them more useful to their children than their parents had been to them. </p>
<p>Evidence from the programme reinforced the effectiveness of two-way communication – parent and child spending enough time together and expressing their opinions. </p>
<p>A father from Viwandani said this of his relationship with his daughter: </p>
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<p>I can say before this project, she was not open, but nowadays she is open and tells me whatever is going on in her life.</p>
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<p><strong>Monitoring progress in school and homework support:</strong> My findings showed that one of the ways in which parents can monitor their children’s progress is by following up on their <a href="https://aphrc.org/publication/advancing-learning-outcomes-and-leadership-skills-among-children-living-in-informal-settlements-of-nairobi-through-community-participation-2/">participation in school</a>. This requires that parents have a good relationship with teachers. As a mother explained: </p>
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<p>You must collaborate with the teacher since sometimes some children go to roam around, and when as parents we are called by the teacher, we refuse to go. So we must work together and become one.</p>
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<p>On the subject of homework support, a father from one of the study sites explained: </p>
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<p>Initially, when the child comes with the book, you as parents are not even bothered to look at it. But when we attend the (ALOT Change) meetings, we are told what is happening so we know where to start or follow up with our children. </p>
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<p><strong>Knowledge of adolescents’ whereabouts:</strong> The need to know the whereabouts of adolescents and the friends they keep is of utmost importance. One mother said:</p>
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<p>The children could easily be pressured into engaging in the many social ills around them … as parents, we contribute because you look at the friends your children walk with … in this community, the friends are the ones who mislead. </p>
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<p>When parents were asked about their obligations to adolescents, they prioritised the provision of basic needs, such as food and shelter. As one mother said:</p>
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<p>It is a parent’s responsibility to make sure that she gets to know the progress of the child, and also it is a parent’s responsibility … to give them food, shelter. </p>
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<p><strong>Championing success at the community level:</strong> Parents also reported that they had teamed up with the larger community to be champions of change. They were passing on lessons learned from ALOT Change to community members who were not part of the programme. </p>
<p>A mother from Korogocho observed that:</p>
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<p>If you see a child doing other things, you just ignore because he is not yours. That does not help us or Kenya. Maybe this child would have been a leader. </p>
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<h2>Way forward</h2>
<p>Parental involvement is a major ingredient in a child’s educational success. Parents are leaders in the home and collaborators with teachers. This means parents need to provide basic necessities, provide a safe environment where a child studies and know the whereabouts of their children when they are not in school. They also need to offer support with school work. </p>
<p>Overall, the success of adolescents in school is an outcome of communication.</p><img src="https://counter.theconversation.com/content/192149/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Benta A. Abuya does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Parents are enablers, motivators and facilitators of their children’s education.Benta A. Abuya, Research Scientist, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1835532022-06-01T15:05:51Z2022-06-01T15:05:51ZKenya’s push for affordable housing is creating opportunities despite barriers<figure><img src="https://images.theconversation.com/files/466327/original/file-20220531-14-5ec50t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">At least 57 of the government's affordable housing units completed so far have been allocated to the KDF soldiers</span> <span class="attribution"><a class="source" href="https://twitter.com/kdfinfo/status/1347233774539579395/photo/1">Courtesy/Kenya Yearbook Editorial Board</a></span></figcaption></figure><p>In Kenya, the right to housing is embedded in the <a href="https://www.klrc.go.ke/index.php/constitution-of-kenya/112-chapter-four-the-bill-of-rights/part-2-rights-and-fundamental-freedoms/209-43-economic-and-social-rights">constitution</a>, which provides that “Every person has the right to accessible and adequate housing, and to reasonable standards of sanitation.” </p>
<p>At the start of his second term in 2018, Kenya’s President Uhuru Kenyatta launched an affordable housing programme as one of the <a href="https://kippra.or.ke/how-the-government-can-achieve-the-big-four-agenda-on-housing/">big four agenda</a> pillars to promote long term economic development. The other pillars are food and nutrition security, a robust manufacturing sector and universal healthcare.</p>
<p>Kenya needs to build 250,000 units annually for at least four years to plug its cumulative housing <a href="https://www.worldbank.org/en/country/kenya/publication/kenya-needs-2-million-more-low-income-homes-building-them-would-boost-its-economic-growth">deficit</a> of two million units.</p>
<p>The lowest cost of a new house is <a href="https://housingfinanceafrica.org/countries/kenya/">estimated</a> at $11,000 (KSh1.1 million), and only about 11% of Kenyans earn enough to support a mortgage. Public and private housing developers have previously concentrated on the middle and high-income groups. </p>
<p>Little attention has been given to producing affordable housing to the poor segments of the population, who form the <a href="https://www.knbs.or.ke/download/sdg-gender-fact-sheet-2021-kenya/#">bulk</a> of Kenyan society – 53% by the end of 2020. As a result, over 60% of urban households in Kenya <a href="https://theconversation.com/kenyas-slums-are-a-haven-for-viruses-heres-what-we-know-134566">live</a> in slums where they struggle to raise $10 a month for rent. </p>
<p>The government pledged to build 500,000 housing units for the lower and middle-income population segments by 2022. The units were to be sold at a price range of US$6,000 to US$30,000. But by the end of 2021, the five-year plan had <a href="https://www.businessdailyafrica.com/bd/economy/state-affordable-housing-drive-added-93-homes-last-year--3817674">yielded</a> only 431 units or 0.8% of the target. </p>
<p>Our <a href="https://www.researchgate.net/publication/341712597_Affordable_Housing_in_Kenya_Status_Opportunities_and_Challenges">study</a> examined the current status of the affordable housing strategy, aiming to identify the opportunities it presents and what’s hindering progress.</p>
<p>We looked at the first project in the programme, in Nairobi’s Ngara Estate, which has so far delivered 228 affordable units. It has created extensive opportunities for investment in construction, and the manufacture and supply of building materials and components. But it faces various challenges which will have to be overcome if the programme as a whole is to succeed.</p>
<h2>Demand and supply</h2>
<p>Provision of affordable housing remains a problem, not only for developing countries like Kenya, but also many developed countries. The rapid increase in urban population, high cost of construction, finance costs, and escalating prices of urban land are hurdles in Kenya.</p>
<p>In the early and mid-2000s Kenya’s government proposed a raft of tax incentives to stimulate supply and demand for housing. </p>
<p>But demand continued to exceed supply. Only 50,000 housing units were <a href="https://housingfinanceafrica.org/app/uploads/114115-NWP-PUBLIC-add-series-86p-Kenya-Economic-Update-FINAL-Edition-15.pdf">constructed</a> annually in Kenya’s urban centres against the annual need of 250,000. Out of these, only 2% <a href="https://www.habitat.org/where-we-build/kenya#:%7E:text=The%20housing%20need%20in%20Kenya,or%20build%20their%20own%20home.">target</a> lower-income families. Affordability problems <a href="https://scholar.google.com/citations?view_op=view_citation&hl=en&user=HKHBDv4AAAAJ&citation_for_view=HKHBDv4AAAAJ:d1gkVwhDpl0C">remain</a>. </p>
<p>Kenya’s affordable housing programme includes:</p>
<ul>
<li><p>the state-controlled <a href="https://www.businessdailyafrica.com/news/State-backed-mortgage-firm-to-lend-at-below-10pc/539546-5127852-o737ndz/index.html">Kenya Mortgage Re-Finance Company</a>. Its role is to mobilise cheaper finance from local and international institutions for onward lending by local mortgage providers at 7%, which is half the prevailing commercial rate.</p></li>
<li><p>the National Housing Development Fund to mobilise funds from potential house buyers</p></li>
<li><p>tax incentives for housing development and home acquisition.</p></li>
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<h2>Slow uptake</h2>
<p>The project we studied, Ngara Estate, is being built on nine acres of land at a cost of US$50 million (KSh5 billion). It is being built and financed by the Chinese government. The project includes a nursery school and shopping centre, among other communal facilities. Its 1,370 housing units are to be sold at US$10,000 for a one-bedroom, US$20,000 for two-bedroom and US$30,000 for a three-bedroom house.</p>
<p>Houses are to be allocated by lottery. Kenyans interested in the houses are supposed to register online giving personal details such as employment status, household particulars and preferred area of residence.</p>
<p>The government of Kenya provided land and mortgage facilities to the middle-class buyers of the project.</p>
<p>Based on data obtained from texts, interviews, observation, discussion, media review, and government’s published manuals, we found that uptake of the completed units was slow. This is because most applicants are unable to raise the 12.5% of home value required to participate in the lottery for house allocation. </p>
<h2>Opportunities and challenges</h2>
<p>The Ngara project has generated 650 direct job opportunities for artisans in the informal sector. Use of locally available resources, labour and artisans in the housing programme could lower costs and employ thousands of Kenyans. </p>
<p>Another finding is that building designs and components can be standardised and prepared offsite, then transported and assembled. This would cut costs and time.</p>
<p>Our study found that innovative and alternative building materials and technologies could also achieve savings. A number of public and private companies producing alternative building materials are in operation in Kenya.</p>
<p>On the other hand, challenges of the programme include:</p>
<p><strong>Funding:</strong> Housing and real estate development is a highly capital-intensive venture and funds are in short supply. </p>
<p><strong>Shortage of land for development:</strong> The project requires land which is serviced with infrastructure and in good locations. But such land is in short supply in Kenya, and therefore expensive.</p>
<p><strong>Cost of construction:</strong> Design, materials and labour make up 50–70% of housing development cost. </p>
<p><strong>Poor physical and social infrastructure:</strong> Infrastructure is lacking in many urban centres in Kenya and developers often transfer the costs of infrastructure to end buyers. </p>
<p><strong>Bureaucracy:</strong> Many agencies are involved in the approval and licensing of housing development proposals and this makes the process lengthy, costly and complicated. None of the laws and standards in connection with building construction directly addresses development of mass affordable housing.</p>
<p><strong>Resettlement:</strong> People are being moved to make way for affordable housing projects.</p>
<h2>What should be done</h2>
<p>Developers, contractors and other players in the housing industry should harness the opportunities available for mass housing development. </p>
<p>The government and professionals in the built environment sector should educate the public about the benefits of alternative materials and technologies. </p>
<p>The state should open up more land for affordable housing. </p>
<p>The National Housing Development Fund should consider more sources of finance, such as the capital market. </p>
<p>A policy framework is needed to guide design, size of units, location and long-term maintenance. </p>
<p>More public participation and consultations should be conducted to avoid resistance to relocation.</p><img src="https://counter.theconversation.com/content/183553/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The Ngara project is only 17% complete but has so far generated 650 direct jobs for artisans.Raphael M. Kieti, Real Estate Lecturer, University of NairobiRobert W. Rukwaro, Professor in the Department of Architecture & Building Science, University of NairobiWashington H.A. Olima, Professor of Land Taxation, Urban Economics and Property Valuation, University of NairobiLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1676622021-09-12T08:19:06Z2021-09-12T08:19:06ZPasha 124: How Nairobi’s informal settlements got their names<figure><img src="https://images.theconversation.com/files/420274/original/file-20210909-27-tsua8v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> </figcaption></figure><p>Nairobi, Kenya’s capital city, started as a railway depot in 1899 and developed into a colonial administration centre, then into a commercial and regional hub. Informal settlements in the city grew in parallel, arising from colonial policies that excluded local people from permanent residence, and driven by demand for housing. </p>
<p>The names of these informal settlements – and the names of places within them – capture their history and act as a voice for their residents. Place names tell us about politics, culture and the challenges of people who live there. </p>
<p>In today’s episode of Pasha, The Conversation Weekly’s Gemma Ware chats to Melissa Wanjiru-Mwita, a lecturer at the Technical University of Kenya, about Nairobi’s informal settlements and how they got their names.</p>
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Read more:
<a href="https://theconversation.com/the-fascinating-history-of-how-residents-named-their-informal-settlements-in-nairobi-159080">The fascinating history of how residents named their informal settlements in Nairobi</a>
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<p><strong>Photo:</strong><br>
“Kosovo, the name of an area in an informal settlement.”
By Mélissa Wanjiru.</p>
<p><strong>Music:</strong>
“Happy African Village” by John Bartmann, found on <a href="http://freemusicarchive.org/music/John_Bartmann/Public_Domain_Soundtrack_Music_Album_One/happy-african-village">FreeMusicArchive.org</a> licensed under <a href="https://creativecommons.org/publicdomain/zero/1.0/">CC0 1</a>.</p>
<p>“Back To My Roots” by John Bartmann, found on <a href="https://freesound.org/people/frankum/sounds/393520/">Freesound</a> licensed under <a href="https://creativecommons.org/licenses/by/4.0">Attribution 4.0 International License.</a></p><img src="https://counter.theconversation.com/content/167662/count.gif" alt="The Conversation" width="1" height="1" />
The place names of Nairobi’s informal settlements offer a glimpse into the realities of people who live there.Ozayr Patel, Digital EditorLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1467762020-09-23T14:23:12Z2020-09-23T14:23:12ZPasha 81: A closer look at the informal water market in Kenya<figure><img src="https://images.theconversation.com/files/359532/original/file-20200923-21-6lq4ap.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">GettyImages</span> </figcaption></figure><p>Water is a scarce resource. In certain parts of Nairobi, Kenya, water is hard to come by. This has created a market for informal vendors to exist. Often these vendors sell water at highly inflated prices and they often take water from cut municipality pipes, which can lead to contaminated water. But the vendors are necessary because they provide people with water which they would normally struggle to access. This means that steps need to be taken to ensure that water is provided to people in a cost-effective and safe way. </p>
<p>In today’s episode of Pasha, Anindita Sarkar, an assistant professor at the University of Delhi, explains how water is supplied in settlements like this – including through water ATMs – and how the market can be improved. </p>
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Read more:
<a href="https://theconversation.com/kenyas-urban-poor-are-being-exploited-by-informal-water-markets-144582">Kenya's urban poor are being exploited by informal water markets</a>
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<p><strong>Photo:</strong>
“A young boy carries heavy water containers to his home in the back alleys of Mathare informal settlement on July 9, 2020 in Nairobi, Kenya.” By Alissa Everett found on <a href="https://www.gettyimages.com/detail/news-photo/young-boy-carries-heavy-water-containers-to-his-home-in-the-news-photo/1271526328?adppopup=true">Getty Images</a></p>
<p><strong>Music</strong>
“Happy African Village” by John Bartmann, found on <a href="http://freemusicarchive.org/music/John_Bartmann/Public_Domain_Soundtrack_Music_Album_One/happy-african-village">FreeMusicArchive.org</a> licensed under <a href="https://creativecommons.org/publicdomain/zero/1.0/">CC0 1</a>.</p>
<p>“Chamber Ambience” by Nasienie, found on <a href="https://freemusicarchive.org/music/Nasienie/Private_Loops/01_nasienie_-_chamber_ambience">FreeMusicArchive.org</a> licensed under <a href="http://creativecommons.org/licenses/by-nc-sa/3.0/">Attribution-NonCommercial-ShareAlike 3.0 International License.</a>.</p><img src="https://counter.theconversation.com/content/146776/count.gif" alt="The Conversation" width="1" height="1" />
The main reason for the growth of the informal water market is government failure to deliver adequate public services.Ozayr Patel, Digital EditorLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1031212018-09-26T12:57:46Z2018-09-26T12:57:46ZObesity and economic status: what we found in Kenya’s slums<figure><img src="https://images.theconversation.com/files/237292/original/file-20180920-129847-1vjxei.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Conditions in Kenya's slums like Mathare are not conducive to healthy life choices.</span> <span class="attribution"><span class="source">EPA/Daniel Irungu</span></span></figcaption></figure><p>Africa is experiencing a demographic and nutrition transition. More and more people are moving to urban areas. Slum communities currently constitute <a href="https://unhabitat.org/slum-almanac-2015-2016/">about</a> 56% of the urban population in sub-Saharan Africa. That’s more than 200 million people, more than the entire population of Nigeria. </p>
<p>Even as under-nutrition or not getting enough calories and nutrients – continues to be a problem particularly among the poorest, overweight and obesity are growing challenges in poor urban areas. Being over a healthy weight invites a <a href="http://aphrc.org/post/research_taxonomy/infectious-and-non-communicable-diseases">host of non-communicable diseases.</a></p>
<p>Recent <a href="https://www.tandfonline.com/doi/abs/10.1179/2046905514Y.0000000147">research</a> suggests that rapid increases in obesity are a result of complex interactions between factors such as people eating higher-calorie diets and engaging in lower levels of physical activity. Genetic and environmental factors also play a role.</p>
<p><a href="https://www.cambridge.org/core/journals/global-health-epidemiology-and-genomics/article/body-mass-index-and-wealth-index-positively-correlated-indicators-of-health-and-wealth-inequalities-in-nairobi-slums/14CD4E919261FBA59A647E2ABBCC7EDD">Our research</a> set out to establish the relationship between obesity and income levels in poor urban areas. </p>
<p>Previous research has established wealth as a potential <a href="https://www.ncbi.nlm.nih.gov/pubmed/15654409">risk factor</a>. But there have been questions about exactly what the link is, and whether income and obesity levels are linked even in urban slums where all incomes are very low, yet there is some variation in socio-economic status. </p>
<p>We set out to investigate the relationship further. Our aim was to gain insights that would inform strategies to manage obesity in Kenya’s poor urban areas.</p>
<p>Our research found that there was an association between relatively higher economic status and levels of obesity in a slum setting. The study suggests that obesity levels are higher in the higher economic brackets – and particularly among women. </p>
<h2>The research</h2>
<p>The study was done in two Nairobi slums, Korogocho and Viwandani. Data was collected between 2014 and 2015. More than 2,000 adults between 40 and 60 years of age were included in the study. Data on weight, height, and basic socio-economic variables were collected by experienced and trained field workers. </p>
<p>We examined the association between a measure of socio-economic status – calculated by combining information on living conditions and household assets – and body mass index which is used as a measure of obesity. </p>
<p>We found that one fifth of our study population was obese. And nearly six times more women were obese than men – 32.2% compared to 5.6%. </p>
<p>We found a strong association between body mass index and socio-economic status. Women higher up the economic ladder were more likely to be overweight. The association was higher for women than for men. </p>
<h2>Interventions</h2>
<p>The findings support the idea that economic status could potentially be used as a predictor of overweight and obesity in slum settings though this would need further exploration. Such predictors could prove useful for rapid assessments of health and socio-economic status in slum populations.</p>
<p>But policymakers must strike a careful balance. As incomes increase among the very poor, body mass index increases – which is good for those who are underweight. But for those who are already a healthy weight, increasing incomes mean slum dwellers have a higher likelihood of becoming overweight or obese. </p>
<p>Women are particularly at risk. This could mean that much needed socio-economic development in urban slums could also usher in unintended increases in overweight and obesity, putting slum dwellers at increased risk of non-communicable diseases – even as they continue to face threats from communicable diseases common to areas with poor water and sanitation facilities. </p>
<p>Because of this, interventions that aim to improve the socio-economic status of individuals in urban slums should, as a starting point, integrate health promotion programmes targeted at prevention of obesity. Future policies targeting the health of slum populations should prioritise interventions for overweight and obesity among higher income groups, and underweight for the poorest.</p><img src="https://counter.theconversation.com/content/103121/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A study in Kenya found that that there’s an association between relatively higher economic status and obesity in a slum setting.Shukri F. Mohamed, Research officer, African Population and Health Research CenterTilahun Haregu, Honorary Fellow, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/699392016-12-18T16:04:23Z2016-12-18T16:04:23ZSlum health is not urban health: why we must distinguish between the two<figure><img src="https://images.theconversation.com/files/148849/original/image-20161206-25746-t22o9h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Just another day in Nairobi's Kibera slums. Slums are characterised by densely packed settlements with inadequate provision of services.</span> <span class="attribution"><span class="source">Reuters/Noor Khamis</span></span></figcaption></figure><p>We live in an urban century. Already more than <a href="http://www.unfpa.org/sites/default/files/pub-pdf/695_filename_sowp2007_eng.pdf">50% of the global population</a> lives in urban areas. The United Nations estimates that by 2030 <a href="http://www.unfpa.org/sites/default/files/pub-pdf/695_filename_sowp2007_eng.pdf">five billion</a> of the world’s population of eight billion will be urban. Most of the growth in urban areas is expected to occur in the developing countries of Africa and Asia, continuing a trend seen in the past decade. </p>
<p>Rapid urbanisation in developing countries has been characterised by an accompanying proliferation of slum areas. Cities such as Nairobi, Kenya; Mumbai, India and Rio de Janeiro, Brazil are home to some of the world’s largest slum areas. Sub-Saharan Africa has an especially high number of slum inhabitants: <a href="http://www.unfpa.org/urbanization">62% of its urban population</a> lives in slums.</p>
<p>Slums constitute a large part of today’s urban reality and will likely persist as a significant feature in our urban future for decades to come. By 2030, projections indicate that <a href="http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)31650-6.pdf">two billion</a> of the global urban population will live in slums, mostly in Africa and Asia. </p>
<p>Despite increased global awareness about the presence and persistence of slums, the health of their inhabitants is a little-studied phenomenon. The health of the urban poor, people with low socio-economic status living in urban areas, is usually conflated with that of slum dwellers. However, health outcomes for these two groups of urban populations often differ given the spatial differences of the areas they live in. </p>
<p>Slums are characterised by densely packed settlements with inadequate provision of services and infrastructure. These include sanitation, water, electricity, waste management and security among others. These conditions expose residents of slum areas to the spread of disease and poor health outcomes that are fuelled by their intimately shared environments. </p>
<h2>Neighbourhood effects</h2>
<p>The mechanism through which densely packed environments affect slum residents’ health is termed neighbourhood effects.</p>
<p>The influence of neighbourhood effects may result in poor health outcomes for slum inhabitants in comparison to non-slum dwellers. Studies done by the African Population and Health Research Center (APHRC) have shown that <a href="http://aphrc.org/wp-content/uploads/2016/10/Ezeh_The_health_problems_of_people_who_live_in_slims_Lancet_2016.pdf">child mortality is higher in slums</a> than in non-slum areas and even in rural regions.</p>
<p>Residents of slums are also likely to <a href="http://aphrc.org/wp-content/uploads/2016/10/Ezeh_The_health_problems_of_people_who_live_in_slims_Lancet_2016.pdf">experience higher rates of undernutrition</a> compared to those from non-slum areas. This may lead to stunted growth and development among children. There tends to be a high transmission rate of infectious diseases in these overcrowded areas because waste collection, water and sanitation are lacking.</p>
<p>However, neighbourhood effects may also exert a positive influence on health outcomes if harnessed appropriately. The high population density of slum areas offers opportunities for economies of scale in the implementation of interventions. This means that benefits arising from interventions can reach a high number of people in slum areas at a relatively low cost. </p>
<p>The existence of neighbourhood effects also means that slum areas can benefit from increasing returns on investments. A good example of this is seen in the <a href="http://aphrc.org/wp-content/uploads/2016/10/Lilford_Improving_the_health_of_people_who_live_in_slums_Lancet2016.pdf">provision of sanitation</a>. As contamination from human waste is progressively reduced, the proportion of the slum population experiencing positive health outcomes increases at a faster rate. Where returns on investments in sanitation don’t increase, this failure may be attributed to the small scale of these interventions which do not take advantage of neighbourhood effects. </p>
<h2>Towards a better understanding of slum health</h2>
<p>The growth of slums is a dynamic process. It’s driven by the entry of migrants from rural areas and other city precincts. It is also driven by conversion of peripheral urban areas into slums and the natural increase from birth and deaths in those areas. The growth may also result from degradation of previously non-slum areas due to deterioration in the provision of urban amenities. Another factor is the growth of smaller towns into large cities without corresponding growth in investments in public infrastructure and amenities. </p>
<p>Efforts to curb slum expansion through the provision of low-cost housing, relocation of inhabitants and restriction of migration have been implemented with mixed success. Slums continue to expand in many developing countries.</p>
<p>More than 800 million people live in slum areas globally. And yet very little is understood about their health vulnerabilities. The impacts of neighbourhood effects require closer examination for the design and implementation of more effective interventions. Researchers and policy makers would do well to consider slum health as a distinct study area, based on the spatial differences between slums and non-slum urban areas. </p>
<p>The recently published <a href="http://www.thelancet.com/series/slum-health">Lancet series</a> on the health of people who live in slums showed this is a topic that has received little attention. A first step in addressing this would be the identification and inclusion of slums during censuses. This means that urban areas should include the category of “slums” during classification of census enumeration areas. </p>
<p>Some countries, such as Kenya and Bangladesh, already distinguish between slum and non-slum areas. <a href="http://aphrc.org/wp-content/uploads/2016/10/Ezeh_The_health_problems_of_people_who_live_in_slims_Lancet_2016.pdf">Data from the two countries</a> confirm that health outcomes for urban inhabitants of slum and non-slum areas differ in many ways. Other developing countries would do well to adopt this approach as their urban areas and slum populations grow.</p>
<h2>New era presents an opportunity</h2>
<p>The world has embarked on the journey towards attaining <a href="http://www.un.org/sustainabledevelopment/cities/">Sustainable Development Goal Eleven</a>. It calls for inclusive, safe, resilient and sustainable cities. This new era presents the opportunity to better understand slum areas as part of our urban reality.</p>
<p>Examining slum health, as a distinct subject that is separate from poverty and health, will help in the development of interventions that address the unique challenges to health arising from the shared neighbourhoods of these densely inhabited urban environments.</p>
<p><em>This article is based on the <a href="http://www.thelancet.com/series/slum-health">Lancet Series</a> on the health of people who live in slums, published in October 2016. Mwangi Chege, the policy engagement manager at APHRC, also contributed to this article</em></p><img src="https://counter.theconversation.com/content/69939/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Despite increased global awareness about poor conditions in slums, the health of their inhabitants is a little studied phenomenon.Alex Ezeh, Executive Director, African Population and Health Research CenterBlessing Mberu, Head of Urbanisation and Wellbeing, African Population and Health Research Center, African Population and Health Research CenterTilahun Haregu, Associate Research Scientist, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/557722016-03-06T11:21:00Z2016-03-06T11:21:00ZWomen who work are held back by a lack of quality daycare in Africa<figure><img src="https://images.theconversation.com/files/113917/original/image-20160304-17765-1hnd0j8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Women's ability to work is severely constrained by the lack of child care facilities in urban slums.</span> <span class="attribution"><span class="source">Reuters/Thomas Mukoya</span></span></figcaption></figure><p>Women’s economic empowerment hinges on the assurance that quality and affordable child care is available so that they can go about the business of doing their jobs.</p>
<p>Globally, women’s participation in the labour market has remained at around 52% for the last 20 years, according to <a href="http://unstats.un.org/unsd/demographic/products/worldswomen/WW_full%20report_color.pdf">United Nations</a>. But women also bear most of the responsibilities at home, including caring for children or other dependants, cooking, cleaning and other housework. </p>
<p>In Kenya, only 46% of the country’s women participate in the <a href="http://data.worldbank.org/indicator/SL.TLF.CACT.FE.ZS">labour force</a>. For most working mothers, having formal employment may allow them more options for child care. A steady source of income eases their ability to send their children to daycare centres, or even pay for in-home care. </p>
<p>But for the women in Nairobi’s slums, who toil in the informal sector with modest and irregular pay, their likelihood to afford child care is greatly reduced. This is partly due to the increasingly disjointed nature of life in the urban slum where there’s no network of family support. In the past mothers could rely on this network to lend a hand or a watchful eye until a child is of school age.</p>
<p>There has been a growing awareness of the potential to provide daycare for children in Nairobi’s urban slums. But the quality of care varies widely because of a lack of adequate regulation. </p>
<p>Caregivers in this setting lack the support they need to provide quality child care or ways that they should stimulate the children’s environment while their mothers are at work.</p>
<h2>Improving women in the workforce</h2>
<p>Our <a href="http://aphrc.org/projects/creating-better-economic-opportunities-for-women-in-nairobi-slums-through-improved-childcare-options">study</a> is a three-year project. It explores the daycare options available in Nairobi’s slums. It also assesses whether a woman’s ability to work and earn can be improved if quality child care is provided and subsidised. The study provides subsidised and quality improved daycare interventions to mothers in Korogocho, one of the largest slum neighbourhoods of Nairobi. </p>
<p>Almost half of all Kenyan women aged 15 to 49 years have a child under the age of five. For most of these women, participating in the labour force is dependent on concurrent child care responsibilities. </p>
<p>Our aim is to examine the nature and magnitude of barriers to child care, such as high cost and low quality and what impact these have on the way that women participate in the labour force. This will generate critical evidence-based policy recommendations aimed at increasing the participation of women in the labour force.</p>
<p>The results of the study will also provide researchers with insights into ways women’s participation in the workforce can be stimulated and how the gender gap in earnings can be narrowed.</p>
<p>The findings can also serve as the basis for discussions between policymakers and community leaders about how better to meet the needs of mothers with young children.</p>
<h2>A global conversation</h2>
<p>The research findings could have broader impact. Exploring the challenges that women in the most vulnerable and compromised environments face may improve their livelihoods.</p>
<p>This research will feed into the global conversation about women in the workforce, and how to approach the targets outlined in the newly ratified <a href="http://www.un.org/sustainabledevelopment/sustainable-development-goals/">sustainable development goals</a>, in particular, goals five and eight that deal with gender equality and economic growth through employment. </p>
<p>Understanding the choices women have to make to meaningfully contribute to their countries’ development, while also sustaining their households, is a step towards realising economic parity. Economic parity should not only be an ambition for the privileged but for all women.</p><img src="https://counter.theconversation.com/content/55772/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stella Muthuri does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>For most women, participating in the labour force is dependent on whether they have adequate child care they can rely on.Stella Muthuri, Postdoctoral fellow, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.