Challenges in managing and sustaining urban slum health programmes in Kenya
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Objective: To evaluate the challenges in managing and sustaining urban slum health programmes. Design: A cross sectional survey. Setting: Kibera slum in Nairobi, Kenya Subject: Two hundread and fifteen respondent. Results: Out of the 215 respondents, 37.2% were aged between 25 and 29 years, 27% between 30 to 34 years with the least age groups of between 18 and 24 and 45 and 49 at 5.6%. The rest fell in the age group 40 to 44. From observations, Focus group discussions and examination of programme documents, from the project leaders hardly tallied with the findings in some aspects such as collaboration, duplication of efforts and capacity building. These were hardly implemented in the projects, according to the data gathered. The common responses on challenges included insecurity, inadequate funding, high donor demands and lack of trust from partners and community. These reports from the programme leaders tallied with those from the community members’. The community respondents cited lack of accountability by projects, inadequate or lack of capacity building, inadequate communication on progress and reluctance to hand over projects to the community, among others. They expressed the view that literally all programmes implemented in the area either continued on period extension managed by the same organisation or close at the end of programme life, thereby making them go back to where they started. Conclusion: Land and income were big issues according to the responses. The other issue, which was of great concern to the community, was income. However, it was noted that a lot of efforts have not been made to diagnose these problems and address them. Capacity building in communities is key, and it may be the starting point in participation. This may ease implementation and go a long way to ensure sustainability. To scale up delivery, there is need for basic infrastructure services for safe water, sanitation, better affordable housing, waste removal and access to land tenure rights through collaborative effort with local /city authorities. There is need to support income-generating activities, and community managed savings and credit schemes that enable households to secure funds. Sharing of experiences and adoption of more pro-poor policies and practices for slum upgrading and land tenure at local and national levels. Security was highlighted as a major concern which requires to be seriously looked into.
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