The Director of Communications at the Hewlett Foundation, Eric Brown, recently joined members of its Population Program for a field visit with the African Population and Health Research Center, a Hewlett grantee, to see firsthand the challenges faced by residents in Nairobi’s slums. The Center is among the premier social science research centers in sub-Saharan Africa addressing African population and health challenges. The organization publishes high-quality research and engages African policymakers to increase the use of research and evidence in their work. Here’s his report.
NAIROBI, Kenya – On a hot, sunny day, Clement Otendo of the African Population and Health Research Center leads a group of visitors down a rutted dirt path in Korogocho, the third-largest slum in Nairobi. More than a half million people are jammed into 250 acres of land. Korogocho’s dusty dirt streets are lined with people carting water, selling whatever they can – a handful of tomatoes, a jumble of wire, some old dresses. A goatherd leads several dozen goats down a road, and momentary panic ensues when they bolt, half going up one street, and half going up another. Our eyes burn from the smoke of countless cooking fires and small piles of burning trash. This is a community living very much on the edge.
We all have confronted poverty – from the homeless man we walk past outside a local store to the dire images of gaunt children in the developing world. It can be impossible to know how to respond. The first impulse is to want to relieve the immediate suffering and to move people out of poverty. But it’s at least as important to find a way to prevent the poverty in the first place. Clement Otendo and his team are working toward all these important goals.
Each day, they go door-to-door in Korogocho to learn more about the challenges the community faces. The team gathers information about child mortality, people’s health histories, and their reproductive health needs, among other data. In the statistics lie the key to helping solve the community’s many problems. The data will inform government policy about how to spend money and allocate other resources, and help other researchers learn how to conduct effective studies. All told, the team interviews more than 30,000 people a year.
Fact-Based Policies Are a Key to Progress
“You can’t make good policy without good information,” the easygoing, thirty-four-year-old Otendo says. It’s not hard to see how this man with the ready smile and his team are able to encourage residents of Korogocho to give outsiders the information they need for their research. “People in the community know that we are here to help.”
As we walk past a man sharpening knives with a foot-powered grinding wheel, Otendo tells us how Korogocho came to be and a bit of what he’s learned gathering statistics.
Thirty years ago, he explains, people relocating from the streets of Nairobi began to settle on government-owned land on the outskirts of Nairobi. They built crude dwellings – mud and straw, mostly, with a bit of tin here and there. Because residents don’t own the land, slums like this are considered illegal communities. Without title to the land, developers won’t build.
There’s minimal electricity. Some people fashion hazardous-looking connections to the few power lines that run overhead, but it’s dangerous and illegal. There’s no running water and no sewage system. In the past few years, large water tanks were installed throughout the community, and now residents have much better access to drinking water. Next to the tanks are makeshift shops, where you can pay to fill your jerry can and, amazingly, add minutes to your cell phone.
The sanitary facilities are communal pit latrines. When they are full, the waste is removed by hand, put into large drums, and dumped in the river. Sewage also runs in channels in the dirt streets. During May and June, an outbreak of cholera was reported. Diarrhea, tuberculosis, malaria, ringworm, and, of course, HIV are rampant. A woman in a slum like Korogocho is twice as likely to die during childbirth than a woman elsewhere in Kenya.
For Slum Residents, It’s a Fight to Get Health Care and Education
Other public services are scarcely better. Residents who need a doctor must pay at one of the 157 fee-based private health clinics. To make matters worse, there is no functional regulatory oversight of private clinics: it’s buyer beware. There are just two government-run facilities.
Getting a sound education in Korogocho is just as hard. In a slum of hundreds of thousands of people, there are two public schools. If you really want your children to learn to read or write, you must pay for one of the many informal private schools that dot the slum. We visited one, the “Big Pen” primary school, where 274 children attend classes. The classrooms measure about twenty feet square; each class had about forty students. They broke into wide, generous smiles and climbed over each other to reach out to touch us, eager to make personal contact. It’s hard to imagine that they have any sense of the challenges they face.
In the face of this grim reality, Clement Otendo and his team see glimmers of hope. Armed with the fruits of its research, the African Population and Health Research Center now works closely with the Ministry of Medical Services, the Ministry of Public Health and Sanitation, and the City Council of Nairobi to provide these agencies with accurate information about the health and family planning needs of the residents of Korogocho.
The Center runs two free health clinics a year for the residents of the district, with medical staff and other support services supplied by the Nairobi City Council and the Government of Kenya. In addition, the national government provides medical personnel, supplies, and drugs to a community health clinic in Korogocho, and the city council has collaborated in setting up immunization outreach programs. It is a start.
Glimpses of Progress
There are other positive developments. A few years ago, with modest funding from Norwegian Church Aid, residents started a new community radio station, called KOCH-FM, where disk jockeys spin hip-hop and African beats as well as provide health information, take calls, and issue messages of empowerment to young people. We met one young DJ, Dennis Kamau, who has become a minor celebrity in the community. “My program is a very wide program,” Dennis tells me. “It deals with entrepreneurship, youth issues, the strength of a woman, so many things.” Dennis calls his radio show Janjaruka, which is Swahili for “getting wise.” “That’s the purpose of my program,” says Dennis. “You have to janjaruka. You have to become clear. You have to become wise.”
Progress also is being made on sanitation. During our visit, we watched one of three so-called “bio-centers” under construction, a hygienic public toilet with running water that will compost its waste (no dumping in the river) and fuel a public oven (no need for unhealthy charcoal cooking fires). Another program funded by the United States Agency for International Development provides free health care and education for over 600 children with HIV. By providing modern HIV medication and free schooling to these children up to age eighteen, the program has been extremely successful in keeping them healthy and in school.
In fact, in touring Korogocho, you see large posters detailing the work of a number of projects: here the government of Israel has built a school for children with special needs; there the government of Italy is working on a slum upgrading project. Ireland helps fund the bio-centers. Despite this good work, what’s missing, of course, is a comprehensive plan supported by local government. But political will would not be enough to succeed; a successful plan has to be based on a thorough understanding of the needs of the people in the community. It is this latter point that was so clear to us during this visit.
There are limitless debates about how philanthropy can help a community like this. There’s no question that we must find ways to alleviate the immediate suffering of the people we met in Korogocho, and in slums around the world. But philanthropy can play a particularly important part in funding the kind of work that few people will ever know about that simply must be done: collecting data, building strong institutions, and advancing policies that will help solve the problem, not just relieve its effects. The African Population and Health Research Center’s work thus becomes an essential part of figuring out how to best use limited resources to solve difficult problems.
Despite the challenges, Otendo remains upbeat. “We may not see the change day by day, but over time, we see it,” he says. “We are moving forward.”
See video clips from Eric Brown’s trip to Africa here: The Hewlett Foundation’s YouTube page
See additional photos from Korogocho on our Facebook page here: Photos of Korogocho