Diarrhoea outbreak in Africa's largest 'slum': how DEPP has changed lives
An urban network discovered upsurge in illness, then managed the response
"If citizens have poor health, they cannot contribute to development effectively” - Mrs. Peris Achieng a Community Health Volunteer in Kibera, Kenya
by Bessie Nikhozi
Partnerships between international NGO’s, community volunteers, and local government agencies in Kenya are vital to supporting communities in becoming resilient and resistant to possible emergencies. This is especially the case with early warning systems, where the need is to respond to a hazard before it escalates into an emergency and where not one agency, organisation or person has the capacity to identify, warn and respond.
The informal settlement of Kibera in Kenya, is knowns as the largest "slum" in Africa and one of the largest informal settlements in the world – with a population of more than 250,000 people. With 95 per cent of the households living below the poverty line, and 2,222 people per hectare, life in Kibera is tough, with disease and food insecurity liable to spread quickly among the tightly packed community.
The Urban Early Warning Early Action (UEWEA) project discovered that 36% of households had been at least one child experiencing diarrhoea, which meant that the diarrhoea levels in Kibera were at emergency level. Diarrhoea, monitored in children between the ages of six and 59 months, is an important indicator as it is one of the major co-morbidities to malnutrition. Usually, an increase in diarrhoea will be followed by increased cases of acute malnutrition. A response was needed to help alleviate this.
UEWEA consortium worked with existing government systems, community volunteers and Sub County Health Management Teams (SCHMT) to assist in the response activities. The response was carried out through the existing health management structure within the county, with responses such as awareness creation, mass screening, referrals, distribution of commodities and water testing.
Through the mass screening carried out as part of the response, a total of 21,622 children were reached. Of those screened 1,501 were found to be malnourished with six cases of oedema (a build-up of fluid in the body which causes the affected tissue to become swollen) that were referred to health facilities for treatment. During the response local Community Health Volunteers (CHVs) also distributed water purification tablets, Vitamin A, Zinc and deworming tablets.
Some children sleep, others play as a mother sits with her malnourished baby at a day care centre
The first step of the SCHMT led activities was to engage with communities, starting with the leaders, where information on the current diarrhoea situation was shared and possible response measures were discussed. Those involved in the activities included CHVs, Community Health Assistants, officers in charge of health facilities, nutritionists, health care practitioners, village elders, religious leaders and area chiefs. This ensured that the activity had the support and input of all community and local government structures before proceeding.
Hellen Obedi, who runs Nuru day care and children’s centre in Kibera, is one of the community members who were visited during the response. The centre caters for children aged from two months to three years of age. The children are left under her care as their parents go out to work. Many of the mothers who leave their children under her care are single parents who have no one else to look after their children yet they need to earn a living. CHVs visited the centre and screened all the children, three of whom were found to be malnourished and were referred to the nearby health centre for further treatment.
“We are happy Concern also brought water purification tablets which we are now using at the day care,” she said.
CHVs live within the informal settlements and are trained to provide basic health services and information at community level and refer anything beyond their scope to the link health facility. CHVs are therefore best placed to carry out response activities. Because the response was run through the government’s community health structures, working together with community leaders and locally based CHVs, the activities were carried out smoothly.
Peris Achieng, a CHV from a unit linked to Kibera health centre, was one of the volunteers engaged in the emergency response to the diarrhoea outbreak. Because she is part of the community, she noticed that the shortage of safe drinking water had led to diarrhoea in both children and adults. Mrs Achieng and her colleagues had begun visiting households to advise how to treat the available water to make it safe for consumption. They then learned that an intervention was planned through the Sub County health structure.
“When we heard that the government and Concern would be giving additional assistance like water treatment tablets and MUAC tapes to assist in screen children, we were very happy!” she said. “We carried out the exercise door to door, we give out vitamin A tablets, deworming medicine and water treatment tablets. We see this as a very important intervention that should be followed up in the coming months.”
As a resident of this community, Mrs Achieng is passionate about the need to ensure that issues affecting it are properly addressed. She also fully supports tapping into local capacity for emergency response and development, and believes that the government and organisations such as Concern (the UEWEA consortium lead) should continue to work together on the ground because health is a basic right.
The response was well received and provided much-needed help to the communities, but it became clear that basic service delivery remains weak in the urban informal settlements; advocacy is needed to advance this issue. It is said that only the wearer of the shoe knows where it hurts most! This is the direction the UEWEA project has taken. Enabling communities to voice their own issues is the best way to advocate for better services. In addition, the project will work with voluntary community ambassadors who will act as links between the community and the project, highlighting issues that affect their communities at national and regional forums.
With rapid urbanisation occurring globally, the UEWEA project is highlighting the impact of slow onset emergencies in urban areas and the importance of early warning and early action. The UEWEA project is one of the 14 DFID-funded projects of the Disasters & Emergencies Preparedness Programme, mostly coordinated by Start Network. The project recognises that the complexity of urban areas requires a well-coordinated, multi stakeholder, government led and timely response when thresholds are exceeded.