AMREF Kibera integrated schools health

Kibera is one of the largest slums in Africa, with a population of over one million people. Due to its informal nature, it does not receive public essential services like healthcare, sanitation or water, nor education; which is most strikingly illustrated by the flying toilet phenomenon: polythene or paper bags in which human excreta are disposed of by throwing them on roofs or in the cramped allies.

The people of Kibera, particularly women and children, are weakened by water-borne infections hence susceptible to other diseases. Health statistics fromt AMREF’s Kibera Community Based Health Centre indicate that the leading morbidity cases are acute Respiratory Infections (31%) and water and hygiene related diseases like diarrheal diseases and water and hygiene related diseases (diarrheal diseases and eye infections (21%)). This is a result of poverty and lack of an elaborate mechanism within the community to address this.

Goals overview

To improve health of Kibera residents through an integrated school health programme by:
- Enhancing the capacity of pupils, teachers, health care providers, community health workers and communities to address integrated health issues.
- Documenting effects of improved health on pupils’ performance.
- Institutionalizing school health initiatives within the slums by the government and other stakeholders.
- Increasing availability and accessibility of personal hygiene and sanitation enhancing facilities.

Current status

Since the late 90’s AMREF implements an integrated health program in Kibera in order to improve the health of the 97,000 residents of Laini Saba and Mashimoni, two of the 10 ‘villages’ of Kibera.

In 2007, AMREF added a school health intervention to its Kibera programme. Personal Hygiene and Sanitation Education (PHASE), is a successful school health model that has been developed during the late nineties and has been widely implemented in mainly rural settings. AMREF and its partners decided to adjust the PHASE model to the slum context and to start a pilot PHASE project in Kibera.

Up till now the AMREF Kibera PHASE project has supported 40 schools, reaching around 8.500 pupils and their families. Monitoring of the project already showed a significant improvement in health status and school attendance. Furthermore it has been learnt that the scope of health promotion should be broader than sanitation and hygiene alone and should put young women more central.

Project plan

The project described here is part of a big integrated health programme and builds further on the school component within that program. Here, one school is singled out to serve as an example.

Personal Hygiene and Sanitation Education (PHASE), is a successful school health model that has been developed during the late nineties and has been widely implemented in mainly rural settings. Based on the successes of this project in terms of reduction of water borne diseases and school absenteeism, the Government of Kenya has incorporated PHASE into its policy framework. Since most primary schools in Kibera are non-formal and run by community-based groups and other non-governmental institutions. Therefore, the curriculum at these schools deviates from the national curriculum. Moreover, the slum context of Kibera is very different from the rural context in which PHASE was initially implemented.

The communities are encouraged to invest in water storage tanks, latrines and hand washing facilities. This is accomplished by facilitating the realization of these facilities rather than donating them, meaning that AMREF co-finances and mobilizes the community to contribute. In order to measure impact, there are 10 control schools where the intervention is not yet implemented, under the agreement that the control schools would also be included in AMREF’s envisaged upscaling if PHASE proves to be successful in the context of Kibera.

Expected outcomes

• Construction of 1 toilets/bathrooms
• Installation of 1 water tanks and water points
• Construction of 1 shallow open drains
• Purchase and setting up of 1 hand washing points
• 5 stakeholders and health workers trained

The Kibera School Integrated Health Project builds and strengthens community capacity in the slum, based on AMREF’s broad experience of working with vulnerable communities. The involvement of government officials, local community groups, children, teachers, parents, their associations and their wider community will help to create ownership of the project activities, which is crucial for sustaining momentum. Intensive lobby and advocacy will encourage the government to take responsibility for health and education in Kibera.