Public health and utilization level of health facilities in the low income Settlements: a case study of Kibera
Muhinja, Njeri M
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Urbanizationis an aspect of development in the social and economic field which always is accompanied by problems of housing, sanitation and pollution and so are problems resulting from the rising demand for medical and social services. Most towns in Africa are comparatively recent in origin and in a majorityof them, there has been an explosive growth of population. Such rapid increases in numbers, with the consequent strain on health and social facilities, the dislocation of family life and adjustments calleduP9n by various members of the family to suit new modes of life, have created some of the major problemsof our age. Much attention' has been given to the rapid pace of urbanization in the Less Developed Countries in recent years and to the possibility of decline in the level of living in cities as a consequence of this trend. It is considered that unless prompt measures are taken, the large influx of people into the cities of Asia, Africa and Latin America, will greatly overburden those municipal facilities whose function is to maintainand improve social and health standards. One of the principal areas of concern is the field of health, and the possible effects of some aspects of urbanization particularly rural - urban migration, upon conditions of health and mortality level in the cities. Most of the towns of the developing countries lack proper planning. They are characterized by severe in-migration from the rural areas in search for jobs. This has thus brought up emergence of informal settlements that have the poorest infrastructure for health care services. In these areas, the spread of disease is multiplied a thousand times and yet disease can easily be prevented by simple measures such as vigorous health education and regulations by enlisting public support. Thus, health education, . environmental sanitation including sewerage and garbage disposal, and immunization should be important aspects of health work in the towns. Just like any other town of the developing countnes, Nairobi City has grown both in terms of population and physical expansion. The rapid increase in population in Nairobi City places a heavy burden on provision of medical services. Though it has been observed that 80~'oof the present health serqices are found in urban centres, with Nairobi taking the lion's share, the services are still not adequate and the services are not performing to capacity. This research aims at identifying salient issues as regards present and future health planning in Nairobi. This research examines the factors that affect the well being of residents in the low-income urban settlements and the level of utilization of the health services in the settlements of Kibera. The study established that majority of the respondents had attained at least primary education (over 60%) The influence of education on health was also reflected on the actions taken when one is confronted by a health situation. Majority of the residents in Kibera settlements waited tor the situation to get out of hand betare they visited a doctor. This could be attributed to low education levels and lack of knowledge on dangers of ill health and also to lack of money to pay tor treatment. Incomes were low with the majority of the residents earning less than Ksh.2,500/=. The study revealed that those who were getting relatively low incomes tended to experience multiplicity of health problems. Since one illness, once untreated leads to another. The dwelling units were in a dilapidated state. Densitiesare high (1,500 people per hectare). This accelerated the spread of diseases. Due to the high densities and congestion in the dwelling units (6 persons per room) home accidents were a common feature in Kibera settlements. The most common diseases included water borne diseases, AIDS and Sexuallytransmitted infections, Malnutrition and Diarrhea diseases. Infrastructral services are lacking in the settlement. There is inadequacy, unreliability and uncertaint of water supply in the settlement. Sanitation is grossly inadequate in Kibera. Majority of the residents livewithout their toilets and bathrooms. The few available once are for commercial and a user has to pay Ksh.I/= to-relieve himself This has prompted the residents to relieve themselves in polythene bags,whichthey refer to as "flying toilets". The study also establishes the low quality residential environments and poor health are closely related. In Kibera settlements insufficient water supply, poor water quality, overcrowding inadequate garbage disposaland infestation by rats and flies are common place. The study recommends that housing and the general environment should be improved. This could be done through provision of basic facilities like stand pipes. Providing access to small scale credit facilities, upgrading of the existing dilapidated dwelling units, educating the residents on safe and hygienic methods of garbage collection proper food preparation proper practices concerning sickness, maternal care, child care and immunization.