Commercialisation Deprives Kenyan Slum-Dwellers of Proper Healthcare

Healthcare remains out of reach for most Kenyans staying in urban settlements. A recent report of the Global Initiative for Economic, Social and Cultural Rights (GI-ESCR) on the effects of commercialisation of healthcare in the African country highlights the widespread presence of respiratory illnesses and vision-related diseases among such communities due to lack of proper care.

In the absence of technical and human resources to provide overarching, good-quality care and due to an underfunded public health system, most Kenyans have no option but to opt for a network of private providers, who are mostly too expensive.

Sharon Joan, a resident of Nairobi’s Kibera urban settlement who contributed to the creation and sharing of the report, told

People’s Health Dispatch that air quality, exposure to pollutants, etc. creates an environment that is not conducive to health and also causes mental issues.

“For example, where the air is polluted and there are other pollutants, we see health problems such as respiratory diseases and heart diseases with children and pregnant women being much more vulnerable. They find themselves at a much higher risk of developing health-related problems due to environmental pollutants and air pollutants,” Joan said.

Poor management of waste, according to Joan, has been a “key problem” in informal settlements. “You’ll often find that you’re living in a set-up that is so crowded with people—without any drain for waste or other disposal systems for waste materials. So, people will throw waste anywhere: in water, dams and rivers. In turn, they also pollute the water that is meant for consumption,” she said adding that these practices “don’t lead to the required standard of living” and put people at “risk of developing many diseases”.

Besides, industries around informal settlements tend to pollute the environment in terms of the “air we breathe, and also make the environment toxic in other ways”, Joan added. Since industrial waste is sometimes disposed of in dams, people living in slums end up using this water for washing or cleaning up. “And you see clearly that this water is not clean enough for consumption.”

Eating unsafe and unhealthy food also causes diseases. Food sold at informal settlements is often compromised—for example, near a heap of garbage. “The way food and water reach people make them unfit for consumption. They tend to be polluted, not clean and safe for consumption. Essentially, this means there’s little space to maintain hygiene and that we’re exposed to water- and food-borne diseases. When you have an unhealthy food environment or no access to clean water, how would you not be at risk of developing diseases like cholera and diarrhoea?” Joan said.

The health system is unable to address these problems and provide care because “access to health workers or to medicines at public health facilities is a real problem,” according to Joan.

Explaining why Kenyans go to private facilities or other less formal facilities to get medication, she said, “You will often find that a patient might go to a public health facility but after a long queue from morning to evening, he/she doesn’t find the required medicines they need there. You go to the facility around 6 am but only get to consult a doctor around 6 pm. Then you are informed that the required tests cannot be done there and sent elsewhere.”

For example, there’s not a good follow-up or referral system—not even for pregnant women, children or the elderly. “These people need someone to hold their hands while trying to access departmental laboratories. No one is there to care or hold their hands as they seek the care they need.”

However, not even the middleclass can afford expensive private healthcare but still prefer it because of the “follow-up or the warm treatment they receive and the immediate medical care”. They fundraise to get bills paid. “Through different philanthropic organisations, people can raise funds for covering the cost of their medication or treatment.

So, even if the cost is very high, especially for those living in informal settlements, people prefer to go to the private sector in order to receive immediate care and take a chance with the bill,” Joan added.

The difference between the availability of equipment and staff at public and private hospitals was evident during the pandemic. During the pandemic, Joan pointed out, there were not enough ventilators, leading to several deaths. “That should have been an alarm bell that we really need measures and strategies in place to make sure that everyone has access to medical devices they need. At the moment, proper equipment is concentrated at private health facilities but those are not intended to care for people who live in slums.” 

Even in the public sector, many people are at risk of not even getting the services because of affordability. “In terms of medical coverage, public health facilities should be covered by the National Health Insurance (NHI) and that’s supposed to cover most of the expenses. But you’re supposed to pay additionally for medication. And if you have the money to get private health insurance coverage, they will not cover most of the expenses as promised.”

Emphasising that policymakers and the government should ensure that the NHI—which is supposed to protect most people and serve the public interest—does its job, Joan said, “It should cover all costs of medication and treatment for people who cannot afford to pay for their medical care. Everyone should have access to healthcare; the vulnerable should not be excluded just because they cannot pay. The government really needs to invest in public health facilities and in human resources for health too.”

Kenya needs to find ways and strategies to train medical practitioners to ensure that they provide efficient medical services to the people as much as they have to equip the public health system, Joan said. “If all that is not done, we are losing many lives.”

The report has been useful for slum-dwellers because they don’t have a platform to understand and learn about what policymakers plan for them. “Through the report, at my own level and capacity, I’m also able to educate people who are my neighbours and living in informal settlements, to encourage them and show them the importance of this kind of public participation.”

People should actively participate in these discussions because “it helps us see things that we would otherwise miss. For example, as part of the discussion on budget allocation for different health issues, we were recently talking to a group of young people who pointed out that the budget for youth mental health is so low. It shows a gap between where we are and what we need and which is the space where we need to intervene together”, Joan added.

The report was really helpful because people from “our communities, such as village elders, community leaders and people who are most often not perceived to be relevant speakers by policymakers and officials, learned how to raise our concerns and take them up at the right places to improve access to healthcare and define the care we need”, Joan further added.