Poverty and ill-health go hand-in-hand / Dorothy Munyakho

6 World Heahh • November-December 1992 Poverty and ill·health go hand·in·hand Dorothy Munyakho T he rugged earth road snaking its way through closely-spaced rows of dwellings built with mud and tin is repeatedly interrupted by muddy pools of foul-smelling water, flowing from open drains. The monotony is broken by mountains of uncollected garbage. Both the stinking puddles and the garbage heaps provide fun for ill-clad, barefooted children in Nairobi's largest slum, Kibera. Since playgrounds are regarded as a luxury even within Kenya' s planned residential estates, the children of Kibera are doubly disadvantaged. They are constantly exposed to the hazards of environmental diseases quite apart from accidents with discarded tins and broken bottles. This is the legacy of unplanned settlements spawned by the inexorable flux of economic refugees from the countryside to the cities. As I pick my way gingerly along the narrow footpaths, the stench of unmanaged excreta is overwhelming. But for 45-year-old Zainabu Asha, a water-kiosk attendant from one of the community ' s women's groups, the squalor is daily reality, as it is for so many like her. "This is how we live, and life continues", says the single mother-of-four. "Our efforts to get assistance from the city authorities have been frustrated and neglected", she adds. Although Kibera, located some 10 km south-west of the city centre, has an estimated population of 400 000, the slum has only one public and one private school. The children, aged between four and eleven, who play in the muddy puddles and in the mountains of refuse around Asha ought to be in school. But they are not. The limited number of available school places and the various costs involved rule out any education for many of these youngsters. Cost- sharing in the provision of essential Brave moves alone will not provide Nairobi's slum- dwellers with solutions to their sanitation and health problems. Policies need to be revised so as to better meet their needs. Where children have no other playground but garbage heaps . services like education, health, water and sanitation is part of the structural adjustment programmes package that Kenya, like many other developing countries, has to accept. Below the minimum wage For women like Asha, who are single heads of households, the situation is even more complicated as they have nobody to turn to for financial assistance. Apart from the meagre 350 shillings (about US$ 10.90) per month she earns from selling water, which is just about one-third of the government -stipulated minimum wage of about $29, Asha sells vegetables to support her family. "What I get is just enough to take me through the month and pay school fees forAmina (six) and Said (nine). The other two dropped out of school and just stay at home", she says. Asha's plight is not only typical of Kibera, but of the 78 informal settlements that dot Nairobi ' s landscape. Because they are unplanned, they are not equipped with the basic services of healthy living. Apart from schools, highly regarded in the country as the key to better living, other basic services are seriously wanting in these urban slums. Alice Githae, a retired city nurse who now runs a private clinic in Mathare, another of Nairobi's sprawling slums, has chilling tales to tell about sanitation in these settlements. She recounts having to treat a patient with a broken arm who had unknowingly stumbled over faeces packed in a polythene bag. "Due to lack of toilet facilities , people use polythene bags in their rooms and throw the refuse along the paths. This not only causes accidents, but puts everybody at risk of epidemic diseases", she says. They also bathe in their rooms, leaving contaminated water to flow away anyhow. "People who frequent my clinic constantly complain of dysentery and food poisoning", she says. Pit latrines prohibited The urban sanitation situation in Nairobi's squatter settlements is complicated by public health by-laws, which ban such settlements. While the illegal nature of the slums denies them official basic services, slum-dwellers are also banned from taking initiatives World Health • November-December 1992 within their means to improve their own environment. The ban on pit latrines is an example; in the absence of water-borne facilities, pit latrines are the only viable alternative for safe disposal of human waste. Mr C. Odongo, Chief Public Health Officer in the Ministry of Health, explains that pit latrines are discouraged in areas considered to have "adequate means of treatment and disposal" because of the relatively high recurrent cost of emptying them and the risk of ground water pollution. The fact is that the cost of water installation is often beyond the reach of the city's poor. Mr Odongo has another charge to make against pit latrines. "Availability and cost of land may be prohibiting factors when latrines have to be regularly replaced, particularly in urban areas", he says. In Kibera, a nongovemrnental organization called Kenya Water for Health Organization has "turned a deaf ear" to government protests: it has not only built and demonstrated ventilated improved pit latrines but has also introduced a latrine-emptying service in the slums. The mobile mini- vacuum tank is extremely popular and grossly overworked. At any one time, 30 to 60 people are on the waiting list for the service, which has so far benefited over 20 000 families since June 1990 when it was first introduced. In my opinion, only brave moves like these- side-stepping archaic by- laws that stifle innovation- have the potential to improve degraded slum environments. Besides, such moves put the destiny of the slum-dwellers in their own hands. Another nongovernmental organization, the Undugu Society of Kenya, has been a trail-blazer in this kind of approach. Undugu has helped slum-dwellers in Kitui and Kanuku villages ofPumwani, one of Nairobi ' s oldest slum locations, to set up houses, which - while they do not conform to the rigid standards laid down by urban planners - nevertheless guarantee their inhabitants more decent lives. One of the women's groups in the Undugu programme has not only benefited from such efforts to upgrade the squatter settlements but has also built rental premises on public land to earn them income with which to educate their children. My personal view is that brave moves alone will not provide the slum-dwellers with permanent solutions and peace of mind. Policies need to be revised so as to better meet their needs. As Elizabeth Mbithi, Even where basic seNices are provided, they may involve long wailing periods. chairman of the Beba Twende Women's Group in Pumwani, says: "With insecurity of tenure, all this could be demolished at any time." • 7 Mrs Oorothy Munyokho is a journalist and Director of the Inter/ink Rural Information SeNice {IRIS), P.O. Box 1287 1, Nairobi, Kenya. Learning to live better A number of WHO projects in developing countries have deliber- ately linked three objectives for introducing functional literacy. First, the programmes sought to equip women with the knowledge and skills needed to protect and improve the health status of their families. The education included information on nutrition and physi- cal fitness , disease prevention , response to illness, and protection and improvement of the immediate physical environment. Second, theprogrammesaimed at providing the necessary informa- tion and managerial skills to use all available resources and technol- ogy efficiently, so as to increase productivity and raise incomes and purchasing power. Third , functional literacy was seen as a process of empower- ment, since it enhanced the knowl- edge and understanding needed to identify the sources of their prob- lems and take counter-measures. Literacy also increased the capac- ity of vulnerable groups to exercise choice and take decisions on mat- ters affecting their well-being , and it created an appreciation of the value of good health as an essen- tial aspect of well-being. These programmes are multisectoral and multipurpose. By relating the teaching of basic skills to critical factors of vulnerability, functional literacy is a way of giv- ing women the essential knowl- edge and life skills they need to lift themselves out of their vulnerable condition. Source: Health dimensions of economic refo rm, WHO, Geneva, 1992, p.28.