Ill health puts urban families under pressure in Kenya

Inadequate infrastructure and services, lack of access to financial resources and weak social networks are just some of the difficulties facing urban households in Kenya. These factors make it even more difficult for them to cope with economic difficulties and ill-health.

A study coordinated byresearchers at the University of Birmingham, in the UK, asks how poor urbanhouseholds in the informal settlement of Mukuru kwa Njenga in Nairobi respond to the short term shocks and long termstresses of economic decline, ill-health and HIV/AIDS.

Using a ‘livelihoods’approach, the research characterises households as possessing five forms ofasset – human capital (labour resources, education levels and health), financialcapital (savings, credit, remittances and pensions), physical capital(infrastructure and production equipment), social capital (networks, groupmemberships, relationships) and natural capital (land, water and otherenvironmental resources).

Responses toquestionnaires, focus group discussions and life history interviews reveal thatmost households in the Mukuru kwa Njenga settlement facecontinuing poverty, insecurity and economic hardship. The majority ofhouseholds suffer intermittent health problems, not long term illness ordisability. Although few sampled households admitted to containing anHIV-positive member (because of the continued stigma attached to the diseaseand reluctance to go for testing), focus group discussion participants consideredthe disease to be widespread in the settlement.

The infrastructure andservices available to these households are deeply inadequate. Half of households sampled use a public tap to accessdrinking water. The majority seek treatment for illnesses from non-governmentalprivate or not-for-profit providers and 75 percent do not participate incollective community activities.

Analysis of the use ofhousehold assets in livelihood strategies reveals that:

• Households limit their vulnerability in the face of illness bycontinuing to work while ill; giving birth at home; and sending HIV/AIDSorphans to live with extended family in rural homes.
• The population has relatively high levels of education and skills (89percent of adults sampled can read and write); theirability to realise their potential is limited, however, by poor jobopportunities in the formal sector (only 40 percent work in full-time wagedemployment’ most are engaged in casual labour or micro-enterprise).
• Households have limited financial capital and little access to formalcredit institutions (62 percent have no savings at all).
• Most households have few possessions or business assets (90 percent ofthose sampled live in one-room dwellings and only 4 percent own their own house).
• Social capital – in the form of community organisations and activities –is weak.
• Household ties with immediate relatives, friends and others withinethnic groups are strong. These ties extend to family living in rural areas.

The research concludes withpractical recommendations for strengthening the assets of poor urban householdsand for improving their ability to manage, access, and transform these assets.Policy makers are advised to:

• Target males more effectively in HIV/AIDS policy (such as the KenyaNational HIV/AIDS Strategic Plan).
• Create an enabling environment for businesses in informal settlements –by improving infrastructure, promoting micro-finance institutions, allocatingsuitable business sites and applying appropriate pro-poor standards.
• Upgrade facilities and services within the slums, under partnershiparrangements, involving government, civil society, theprivate sector and development partners.
• Draw from the experience of non-governmental organisations in Nairobi topromote community mobilisation and the formation of community groups.
• Develop a mechanism for coordinating institutional responses to theneeds of poor households in Nairobi.
• Create a framework for local development planning, within whichdifferent stakeholders can work together.