Integrating COVID-19, TB Prevention and Gender UHC Goals in Strategic Quality Life Plans Targeting Peri-Urban Nairobi Areas: A Case for East Leigh, Rongai and Kitengela, Kajiado Kenya

Authors: Tom Muyunga-Mukasa, Raymond Brian Sebyala, Hudson S., David Kyobe, Arthur Edwards Kiwanuka, Chris Wasswa, Ainebyoona Rodgers, Madrine N.

Universal Health Coverage (UHC) is an over-arching ideal, goal, commodity and resource which can be claimed, is demanded, supplied and packaged as a service or outcome.

 It is a stimulant and catalyzer for social development and an indicator of standard of living. It is deliberated upon by those in the policy, programming and planning areas.

However, UHC cannot be beneficial unless it is in existence with other elements such as: well organized population groups, planned estates, well connected locations with road systems, well conserved biodiversity, institutionalized systems, policy regime, rights regime, strategic development, delivery of services, provision of services without discrimination, social care services, conducive climate, wellness, mental and physical health.

This realization was arrived at because of our work with refugees in East Leigh, Rongai and Kitengela suburbs outside of Nairobi City, Kenya. We meet and interact with citizens and refugees. We are TB case finders and since August 2019, after we had trained 400 Champions and through them identified 177 TB cases. We were able to encourage them to adhere to medication. 75 of these were living in overcrowded houses and all claimed they smoked pipes and cigarettes to numb hunger or cope with traumas. 72 are living with HIV and had acquired active TB due to compromised immunity. 35 had missed medication as a result of moving from one place to another. But, resumed when they got stable housing. For 12 the kind of stable housing is a church where they sleep during night when it is not in use. For (17) seventeen it is working as home maids during day and sex-for-bed favour changers. 83 are hawkers and use the money they get from hawking to subsist.  There is so much one can tease out of this characterization. There are bare vulnerabilities to COVID-19, TB, HIV and Malaria.

 Kenya enforces an encampment policy so it would be so hard for programmes providing for urban refugees to cater for livelihood and comprehensive self-reliance. To a very large extent this has to be done by the refugees themselves. Refugees are not allowed to vote in Kenya so politicians don’t see any ballot-value in them. It is no wonder these areas of residence with a larger number of refugees seem to be dismissed during election time. It means they do not get allocations as much as those areas where politicians get votes. However with increasing dignity-affirmation dispensation following the call for Sustainable Development Goals, roll out of human rights and the power of organization, refugees have developed among them cultural, economic and labour power blocks. This has turned out differently for different groups.  There is an increased demand for community organization opportunities. This is a leverage to segue into organizing around themes such as: #LivelihoodSupport #EliminationOfViolenceAgainstWomen #EqualityForAll, #EachForEqual #GenerationEquality #ZeroDiscrimination the #EndTB and #EndCOVID19.

At the local government level and in residential communities where refugees reside life goes on normally. Some refugees are professionals and this has helped them get work to earn and afford a regular subsistence. Others are perceived as unskilled labour readily taking on lowly jobs not taken up by citizens. There is a building boom in Nairobi and the suburbs. So, there is demand for food, human-power, security guards, porters, brick-layers, retailers, brokers and other service providers. Refugees have taken up these jobs and have been effective. In Kitengela, there various retail-groceries run by refugees and they are social-support drop-by places too. Refugees use these to pick up leads for jobs; they are referral places and this makes it easier to track progress of refugees referred to certain jobs.  This in turn has brought about informal trust-building mechanisms or connections. Job-seekers are able to meet job prospects with good references.

This and more constitute the background against which, UHC can be claimed and achieved. The TB persons we identified are able to adhere to medication-taking because they are now able to earn some money to afford subsistence as well as living within a known social support system. This has been the backdrop of our work until the advent of COVID-19.

With the ‘social distancing,’ self-isolation and other quarantine protocols, we have had to change tactics. First and foremost, we had to transition into adopting Virtual Work platforms. We had just completed community outreaches and ensured our beneficiaries living with TB and HIV had food and medication supplies taking them up to May or June. Then COVID-19 happened. We have come up with activities which our beneficiaries can emulate while they are staying home. Strategic plans have been drawn to occupy the days with activities. We are continuously learning newer tricks to use the computer to create virtual communities of prevention best practices. Some examples include: dissemination of information; education; and communication (IEC) using play skits. We found out a long time ago that one way to pass IEC was through skits which we recorded as audios or videos and shared them. We reach out to refugees from Congo, Burundi, Rwanda, Tanzania, Ethiopia, Sudan, South Sudan, Eritrea, Somalia and other parts of Africa. They have been able to appropriately translate the skit themes into activities they can do locally in their setting.

Universal Health Coverage (UHC) can play the multiple roles as an over-arching ideal, goal, commodity and resource which can be claimed, demanded, supplied and packaged as a service or outcome. This can be possible when it is consumed locally at a bite-size commodity. This is possible when commodities are provided skills to turn knowledge into activities in which they can participate fully. This requires not only individuals organizing, but necessitates a presence of a political regime allowing say, refugees to organize and pursue a fulfilling life. This is how we can best tackle COVID-19 while rolling out popular demand for dignity affirming political, cultural and social contexts.  We have relied on the support of well-wishers from USA, Canada, Europe, Australia, Japan and our own self-help organizations to support ourselves. We would like to be in a better positon to serve refugees and we hope COVID-19 is to wake up many to see refugees as an untapped resource to fight COVID-19, TB, HIV, Malaria and poverty. This is our hope. We desire to contribute to our local host communities. At the end of the day we all belong to the humanity community. COVID-19 cannot tell a refugee from a citizen. Can it?