The paradoxical role of families in women and girls health in slums


Pauline OosterhoffPauline profile

One of the things that strikes one most clearly in working in the slums in Kenya is that, as in many developing countries, the state is barely present in most people’s lives. For the women my colleague Emily Kahega Igonya and I encountered in Nairobi’s slums last week, the government was inactive while they were sold by their sisters or brothers-in-law, tricked into unpaid work with false promises of education, and kicked out of their parental homes as orphans.

Yet Kenya’s recent constitutional reforms are based on the idea that devolution, handing off central government responsibilities to municipalities, can solve people’s problems by bringing government closer to their lives. This seems doubtful, given that for most of the women in slums we talked to, it is family and friends, not the state, that provides them with support. It made us wonder how and to what extent state policies can interfere in dysfunctional families, when it is the family that provides for the services that dysfunctional states fail to provide.

The impact of the new Kenyan constitution on health outcomes

According to the new Kenyan constitution introduced in May 2010, all Kenyans have the right to the highest attainable standard of health. To realise access to health, the constitutional reforms prescribe “devolution”, a transfer of responsibility from the national government to the counties. Devolution should bring the government closer to the people.

Last week Emily and I examined the effects of Kenya’s constitutional reforms on access to HIV and AIDS services for women and girls in Nairobi slums. We worked with HIV-positive women, all young mothers, on digital storytelling to inform policy makers of the effects of these national policies on their health. All women described betrayal in their families –often by other women- that exposed them to HIV, violence, and destitution. Yet it is their sense of family –even if it is just their own children – that allows them to survive in the absence of a functioning state.

When Larissa, a widow with two children, completed primary school in a village, her mother was no longer able to pay for her school fees. She called her elder sister in Nairobi, who offered to pay for her education. Upon arrival in Nairobi, however, her sister told her that she would only pay for school fees if Larissa agreed to marry her husband as his second wife. When she refused, her sister’s husband presented Larissa with a widower with two children who would marry her and pay her school fees if she were to take care of him and his children. She ran away and met a man with a job in a restaurant who paid her school fees and married her. Shortly after the delivery of her second child, he fell ill with AIDS. He encouraged her to seek treatment from international donors but he denied that he was HIV positive to her until the very end. She has now been inherited by his younger brother. He takes good care of her, and she is pregnant with his child. Who is failing women like her?

The implementation of the devolution of health services began last year, with the election of governors and county principals, but it has barely affected these women. For sex workers -some of whom have been involved in sex work since their early teens – the effect on their health has been clearly negative. Municipalities interpret and enforce laws on sex work more harshly than the central authorities did, chasing women off the streets and detaining them. Police detention makes it harder for them to take their AIDS medicines. Sex workers reported having to stop their medication completely, or change to herbal medication. In their perception, devolution means that “law enforcement can now use their cars freely to extort more bribes from us later at night.”

Sex work, the family and state support

For sex workers, other sex workers and community-based organizations are the main form of support after their own family failed. Rose, a young mother, was taken in by older sex workers when she was orphaned at the age of 15 and rejected by her family. She has worked as a sex worker ever since. Sarah’s mother decided that her job was done after her daughter finished primary school. Sarah decided to go to Nairobi to live with her aunt, who could not pay for all her expenses. She had to look for money herself, and at the age of fourteen she found herself on the streets as a sex worker. When her aunt guessed how she made her money, she threw her out, leaving her at the mercy of different men who took her in until they were bored or she became pregnant. Linda finished high school and went to college, hoping to become a secretary. She came to Nairobi to look for work and live with her uncle. He had no money to pay for her. The only people who were willing to help her find a job and a home were bargirls who moonlighted as sex workers.

Women we spoke with –no matter how poor- had done their best to avoid the state health services for years. As Lucy, a young widowed mother of two, explains, “there is no confidentiality, the lines are long and the hours are short, and everyone can see you.” Instead, they obtain AIDS medicines through internationally funded and managed services like MSF and CDC. Kenyan community-based organizations, like HAKI and COTANET, help women to organise themselves and establish their own peer support systems. But for housing, food and other essentials, it is their own family they rely on first. And when that system fails- without any safety net offered by the state, charities or INGO’s – women are exposed to many risks, including HIV. Policies that aim to support the right to health of women and girls in slums need to recognize the central roles of families in responding to governmental irresponsibility.

All names in this article are fictional to protect the identity of the women.

Pauline Oosterhoff is a Research Fellow for the Participation, Power and Social Change (PPSC) team at IDS. She can be found on Twitter as: @PPJOosterhoff

Previous blog posts by Pauline Oosterhoff:


Participatory Action Learning on Gender Mainstreaming in Kenya – Reflections from the Field


By Patricia Njoroge

A little while ago, Robert Chambers blogged about a conference ‘Engaging with Crisis-affected People in Humanitarian Action’ that he attended. Robert reflected on the change from top-down measurement towards accountability to the people he has witnesses over. Patricia Njoroge, who met Robert at the conference got in touch afterwards to share about a Participatory Action Learning project which illustrates the difference a participatory approach can make to people affected by crisis.

In 2013 the World Food Programme (WFP) and IDS launched a Participatory Action Learning (PAL) project ‘Innovations from the Field: Gender Mainstreaming from the Ground Up’. The project is funded by USAID and is being piloted in five countries: Kenya, Malawi, Lesotho, Senegal and Guatemala. The project’s objectives are to learn and sharewhat already works to mainstream gender equality in WFP field programmes. And to apply the lessons to strengthen gender-sensitive practice within WFP.

In Kenya WFP staff identified four themes they wanted to research through the PAL process. In December 2013 the ‘Deepening Understanding of Gender Relations’ and the ‘Communicating with the Field’ PAL Teams undertook a field study at the coastal region, using participatory tools to engage with communities involved in WFP Kenya’s Cash for Assets (CFA) programme. As well as talking about a range of benefits associated with the programme, several programmatic issues were raised by the affected communities. The best we could do was to record these on small hand held video recorders – this had a great impact! On returning from the field these issues were shared with management and steps were initiated to resolve them.participatory action learning 1

Providing feedback to the communities
In March 2014, two members of the PAL teams returned to the study communities and provided feedback on actions taken. Community members very much appreciated that action had been taken on the issues they had raised and also that the fact that the Team was able to visit them again and provide them with feedback. Often researchers collect community members’ views but not all are able to return and give feedback on actions taken with the information provided. The team showed those interviewed a video developed with their recording/contributions. The joy of having a team listening to them, and taking their concern to management, action taken and then going back to give feedback was immense. They said they appreciated that the organisation was now listening to them. They were happy to see themselves on film, with one person commenting about one of the women shown in the videos ‘she is now known across Kenya!’

As part of the analysis of findings, the PAL teams reflected on the use of different participatory tools during the study.

Time Line (12 hour clock)
This tool helped to highlight how men and women spend their time in a day. Where there was a member in the Focus Group able to write, the team guided the discussion and the members would discuss freely and write on the manila papers provided. This was an ice breaker, often causing laughter as participants reflected on how men and women spent their time differently, as well as creating space for discussion on how WFP can engage more men in project activities to reduce the burden on women.

At the end of the session, the list of what men do and women do was distinctive with men having a shorter list while the women’s list was far longer. The men all acknowledged that women do a lot more than men in a normal day and are the first to wake up and last to go to sleep.

When I used this method I found it is very engaging, there’s a relaxed atmosphere and participants don’t focus on themselves but rather discuss and agree on a common general activity to write down. Also, as a start I tell them I want to learn from them (they have the power to teach me about their lives) – all in all a very rewarding and satisfying experience.

Gender Participation in Productive Activities
With the help of this tool participants mapped five main daily activities and through proportional piling they showed how many men and how many women participate in each activity. This was a very participatory exercise as it involved drawing signs of men and women on a manila paper to represent proportions of engagement in various productive activities. It elicited some interesting, and sometimes conflicting, results. For example, in one community a group of women concluded that for four out of the listed five activities (CFA, farming on own land, paid labour, charcoal burning for sale) women represented eight out of ten people doing the activity, while for the remaining activity – drinking boko,(the local brew) – men rated ten out of ten. This resulted in a hilarious moment as one woman tried to point out that there are a few men who look for paid work. Yet in a discussion with young and older men, while they agreed that men’s participation in CFA activities was low at a mere 1 out 10 men, they said they participated more than women in casual labour and equally in charcoal burning. However, they did acknowledge that women’s contribution to income generation on top of their participation in CFA activities meant that in general women were doing more than men.Community members participating in workshop

Problem Census in Communication Tool
The tool helped to clarify how affected communities usually communicate between each other, how they receive information about the CFA project and how information is relayed through different sources and means. The tool also helps identify the preferred/ideal information-flow, including what channels to use in order to ensure communities receive information about projects effectively. This information is not always easy to capture through just verbal focus group discussions, neither is it easy to make people understand what information you are trying to obtain from them. Hence, using this tool to engage people helps both the participants to understand the information they should try to give as well as it assists the facilitator in her/his task to guide the conversation and map out the issues in an easier way.

Benefits of using participatory tools in the project
To sum up, these participatory tools helped in engaging with community members, creating an open friendly learning atmosphere with them educating the team and clearly bringing out issues for discussion. The participatory tools bring the participants closer to the subject and elicit rich discussions on the subject matter. It also holds the participants’ attention and the moderator has less fear of losing their audience.

In the course of the discussion, interrelated problems are discussed and causality factors identified. This provides a good opportunity for those involved to identify measures which can redress the weak points. By using the tools the beneficiaries felt they were in control of the process, telling their story in their own words.

Patricia Njoroge is a Gender and Protection Advocate with the World Food Programme (WFP) in Kenya

Read Robert Chambers’ blog post:

What community dynamics encourage volunteering? Insights from Kenya


Simon LewisSimon photo

Why is there a thriving culture of volunteering in one community while in another there’s hardly any voluntary action to be found? What are the community dynamics that encourage or discourage volunteering? These are some of the questions I have been trying to answer as part of the ‘Valuing Volunteering’ project. This is a global action research project, conducted by VSO in partnership with the Institute of Development Studiesto understand how, when and why volunteering affects poverty.

On a recent trip to Mombasa I was lucky enough to meet and work with members of the Volunteers In Action (VIA) Network – an umbrella group for volunteers on the Kenyan coast. The network looks to organise projects and events on issues of shared concern to volunteers and volunteer organisations; provides opportunities for volunteers to network and organically form their own groups and take forward their own projects; and puts on training directly in response to the needs identified by its members. It’s a passionate and enthusiastic group – something that cannot always be said for all similar groups in Kenya.

We looked to validate some of the findings that emerged from the participatory Systemic Action Research investigation conducted by the Valuing Volunteering Mombasa research group last year. During that exercise local researchers engaged people in three communities across Mombasa and found that the degree of volunteering taking place in each area varied greatly. Discussing this finding with members of the VIA Network, it came as no surprise.

Varying types of community produce different dynamics of volunteering
They see the varying dynamics of volunteering in different types of community across the city and appreciate that a community should not be viewed in isolation but also in terms of its interactions and relationships with other communities. For the purpose of this research project, we understand community to be very practically associated with a neighbourhood or an area that symbolically exists in the local consciousness (for example the local naming of neighbourhoods ).

The Valuing Volunteering research in 2013 found that, in Mombasa communities such as Shanzu and Kongowea, there was a limited amount of local volunteering taking place. Yes, there were some active local youth groups, but a resonating view amongst local community members was that development would not happen here. This collective sense of pessimism eroded social capital and discouraged volunteering. In contrast, research in Mombasa city centre revealed an active and vibrant volunteer environment with numerous volunteer involving organisations.

The discussion with VIA members supported these findings, but the interactions between communities in Mombasa (and the volunteers within them) exposed hidden layers of complexity. Deconstructing community dynamics in Mombasa, the group identified five broad categories of community and their relations to each other.

Five types of community diagram


1. Close knit-communities with high social capital– for example Frere Town in Mombasa, where residents feel a sense of personal investment in their community and often engage in volunteering within its boundaries (internal volunteering) for the good of the community.

2. Affluent urban centres– for example Mombasa city centre. Generally more affluent and home to higher numbers of volunteer involving organisations (particularly larger more formalised institutions) and businesses, the city exerts an influence on surrounding communities, pulling in migrants and commuters in search of work and volunteer opportunities.

3.Transitional communities–for example Mtwapa to the north of Mombasa where members are only temporary or semi-permanent residents. The high turnover of residents results in a lack of commitment to the long-term future of the community and acts to disincentivise volunteering.

4. Informal/less affluent urban and rural settlements– for example the two research locations of Shanzu and Kongowea. Critically, their existence is intertwined with that of the city centre, as residents are drawn to the perceived work and volunteer opportunities in central Mombasa. However, this adds depth to the initial finding that little volunteering takes place in such communities – it may be that there is little volunteering within the community but it is not the case that there are, by association, few volunteers. Instead, those volunteers are commuting to more affluent areas, such as Mombasa city centre, to take up more desirable and numerous volunteer opportunities. The effect is a drain on volunteers (particularly young volunteers) in the home community.

5. Rural/remote communities– cities such as Nairobi and Mombasa are the destination for many internal Kenyan migrants seeking employment, with many relocating from their rural homes. It is a common practice for Kenyans to support their families in the rural homestead through remittances, and some will return to the community to provide support, often in the form of volunteering, typically on a seasonal basis during holidays or later in life. Whilst some activities are successful and well-received, some returning volunteers have noted hostility to their acts of goodwill, particularly on cultural grounds as home communities perceive them as having changed or compromised their beliefs whilst away.

Analysing the dynamics of communities is useful in explaining why volunteering happens in some areas more than others. Crucially, it is not always the case that some communities have more volunteers than others but in some cases volunteers will commute or migrate to volunteer in areas where there are better opportunities or to avoid exploitation and being under-valued.

In the Kenyan context it is also critical to appreciate that the flows of volunteers are closely associated with the flows of people who move for employment opportunities – in fact volunteer and economic migrants/commuters are often the same people. When volunteers commute into the city centre from less affluent communities this is primarily because there is a greater pull factor emanating from the larger number and higher profile of volunteer organisations in the city centre that offer greater prospects for progression onto paid employment. The NGO sector is very desirable for paid employment in Kenya and, for many, volunteering represents a ‘stepping stone’ onto the employment ladder. As such volunteering in Kenya needs to be understood in relation to the factors that are driving the increasing urbanisation of its society and the complex relations and interconnections between its changing communities.

Simon Lewis is an international volunteer with VSO and the lead researcher for the IDS-VSO Partnership ‘Valuing Volunteering’ in Kenya. This is a slightly amended version of an article that previously appeared on the Valuing Volunteering Kenya blog.

Read more recent blogs from the Valuing Volunteering Project:

The K’dogo Economy: Food Rights and Food Riots on Harambee Avenue


Patta Scott-VilliersPatta Scott-Villiers 2013

Lucy strokes the head of one of her two shiny children and hustles them out of the rough wooden door with their school books. She’s wearing a perfectly fitting skirt of blue and yellow African cloth and a yellow T shirt stamped with the words ‘Unga Revolution’. She’s young and she looks determined. ‘Now, see, we skip mealtimes, from three to two to one. You can buy less amount of food. Instead of buying a two-kilo packet of unga (maize meal), because the money is not enough, you buy a quarter or a half, depending on size of the family. In 2007, before the post-election violence, maize was 50 shillings a kilo and now it’s 120 shillings. I earn about 300 shillings a day, mostly, and from that I buy food, pay rent, pay school fees. We are coping up because shop keepers, you see, they have the kadogo economy, a small economy where you can get these few vegetables for five shillings, the package is so-o small… you can get sugar, a spoonful at one or two shillings. Vegetables you buy two leaves, old ones, for five shillings. Meat, sometimes, chicken heads and feet, you put a lot of water and make a soup, twenty shillings.’Dhobi women

In Mathare Valley, the slum where Lucy lives in Kenya’s capital city, Nairobi, the population density is 170,000 in a square kilometre. She moves with confidence along one of the main thoroughfares, a handmade road built out of decades of sedimented plastic bags and sewage. It’s all patched rusty corrugated iron and narrow alleys with washing lines strung between, the main drag lined with kiosks and roadside food stalls, crisscrossed by open drains, people gazing, people drinking, people heckling, ‘careful’ she says, people arguing, people sitting. Every so often an open space, ‘what’s this?’ It burned last year. The landlord wanted the people out. Here, a gang wanted to get rid of someone.

In 2010 Lucy mobilised people from Mathare to join demonstrations for the Unga Revolution – a series of events that mixed working and middle classes in marches to Nairobi’s city centre protesting about food prices. It is part of a growing movement called Bunge la Wananchi, the people’s parliament. Today she’s up at parliament again. Inflated plastic pigs are being tossed between protesters on the steps of the august house – “MPigs! MPigs!” the demonstrators shout – they’re referring to Kenya’s 349 members of parliament who have voted themselves a wage of 852,000 Kenya Shillings a month – and that’s before adding the 469,000 monthly stipend for travel – bringing their claim to over 1.3 million shillings or some £10,000 per month. Lucy and her mother sell vegetables, and earn about £60 a month. She’s alive, but she’s furious. ‘To pay their greedy wages the politicians will put food and fuel taxes up again’, she spits.

Now the steps of parliament are slick with pigs’ blood from the Dagoretti slaughterhouse. The plastic pigs are being butchered and strings of sausages tumble out onto the ruby steps. The blood is coating people’s hands and clothes, the smell is rank, the media delighted. People are throwing one shilling coins into the red sludge – here’s money for you! The scene is on the edge of crazy. It’s what you have to do to get noticed.

The MPs appear to have backed down, and gone for a settlement of only 520,000 shilling per month and a 5 million annual grant for transport, but, on closer inspection, journalists from the Standard newspaper find allowances and concessions that take the figure right back to over 1.3 million.

At the Unga Revolution in June 2010, a few thousand occupied the street between parliament and the office of the prime minister in a noisy demonstration that stopped traffic for the whole day. Late in the day, the protestors extracted a promise of a price reduction from the Prime Minister. When weeks went by and nothing happened, another noisy march on the city a month later produced some subsidised maize meal. It was in the shops for three days.

As global food prices spike and then continue to rise inexorably, Kenya’s Revenue Authority seeks ever more efficient and comprehensive taxation. Basic food prices in Kenya have almost doubled in five years. Despite appeals, value added tax of 16% on maize meal, milk, bread and other basic foods look likely to be implemented this summer. Michael Otieno of the National Taxpayers Association, a lobby group operating out of a residential house in middle class Kilimani, bombards the government and press with data. Every Kenyan will pay 16 shillings a day in tax on Unga maize meal alone, he points out. But, the Treasury has its sights on revenue of 11 billion shillings (£82 million). Another big chunk of government income comes from levies on fuel, forcing prices of food yet higher.

Mathare’s local debate on the causes of food price hikes is sophisticated, but global price volatility doesn’t come into the conversation all that much – the issue here is the obscene inequality between the rich and the poor. Mathare’s vegetable sellers, sex workers, butchers, laundry women and unemployed display an informed understanding of the potentially controllable elements of the political economy. Sharing a newspaper around sheet by sheet, or listening to the radio at Mathare’s jobless corner where the drinking dens spill their customers out onto the main street, Mathare’s citizens follow the latest hair-raising developments. The strategic grain reserve is collapsing under dodgy contracts, prices swell with fake shortages and hoarding, and fat contractors are getting import subsidies for domestic grain shipped from the port at Mombasa for a mile out to sea and back into the country again. The scandals multiply. Today at jobless corner they’re listening to news from parliament – will the new budget bring food prices and fuel prices down?

‘If things don’t shift somewhere’, says Lucy, ‘we’ve no more meals to cut, no way to reduce the size of the pile of shredded cabbage we sell for 5 shillings, no more magnets we can stick to the bottom of our weighing scales.’ ‘We’ll have to shut up shop’, said the chicken-feet seller man joining the conversation with a mix of gloom and fine and ironic gales of laughter.

Kenya doesn’t have a working policy on food prices, but it may be forced to get one, and quick. According to the National Bureau of Statistics, there are nearly 1.5 million people living in slums in Nairobi, that’s almost half the city’s population. Another 1.4 million are classified as low income. Almost everyone on a low income is scrabbling for poor quality food, rent, fees for overcrowded schools, in short, struggling for a normal life. There is almost no one in Mathare who cannot come up with a fairly accurate version of Article 43 of the new constitution, which promises every Kenyan a right to food. But Kenya has, as yet, no policy to cut the rising suffering of the millions on parlous incomes who live in its burgeoning cities. The poor are getting angry and the rich appear to be taking very little notice.

Patta Scott-Villiers is a Research Fellow in the Participation, Power and Social Change research team at IDS.

Previous blog posts by Patta Scott-Villiers

Participatory visual processes in Nairobi’s margins


Thea ShakrokhThea Shakrokh

I recently spent a week in Nairobi with community researchers from The Seed Institute and Spatial Collective (two of the research group members within Participate []) who were learning about participatory video as an action and research strategy within their participatory research initiatives. Participatory visual processes provide creative possibilities for the very real issues affecting people’s lives to be captured. Jackie Shaw from Real Time facilitated a journey through which the researchers gained hands on experience of facilitating a participatory video process, and looked at how the approach could be used to amplify the voices of the most marginalised in their communities, and generate dialogue with decision-makers.

Community researchers in Kasarani, Kenya learning about facilitating participatory video processes.

Community researchers in Kasarani, Kenya learning about facilitating participatory video processes.

The potential of participatory video to visually communicate the context specific issues, concerns and aspirations of community members resonated strongly with the community researchers. As participatory video is a creative process there is flexibility in its use. This meant that in learning about the approach researchers were able to think about ways to connect it to their own visions for action research; it was interesting for example to hear the nuances in the way that the purpose of participatory video was interpreted:

“Participatory video is a tool for highlighting issues on the ground that do not yet have a strong presence in public debate, for example disability issues.”

“It is a group process that enables issues to come out as people have conversations through working together.”

“Participatory video will enable more people in the community to be reached and in an interactive way which will provide community ownership over the issues generated.”

“Censoring of the narrative, which traditionally happens in survey work is removed, the story coming through is true to the detail of what the community members were sharing. Also the authenticity of the voices will remain, for example the language of the youth will be what is heard.”

What came across clearly in the conversations that took place over this week, was the importance the groups placed on the empowering nature of participatory video – in particular, the way that the exploration of community stories is placed at the centre of the process as opposed to starting with the external policy context which is so often the case. By creating a space for issues to be deliberated and communicated collectively, there was a feeling of increased power behind the message articulated.

For me what is really powerful about participatory video is that it provides a space for communities and policy-makers to make connections that are grounded in the reality people’s lives, and their physical spaces. Importantly, in the context of Participate, the digital nature of video makes the perspectives and voices of people living in poverty accessible at the local, national, and international levels; from cross-community dialogues to global policy debates, with strong possibilities of dialogue between the two.


Spatial Collective community researchers sharing the participatory video process with their peers in Mathare settlement, Kenya

The next steps in Nairobi will be to take participatory video to the communities that Spatial Collective and The Seed Institute work which they hope will bring a new dynamic to their work. The Seed Institute are planning to use participatory video to provide new opportunities for children with disabilities to participate in and lead the learning and action activities that they facilitate. The Spatial Collective moved very quickly to share the method across their team of youth leaders who coordinate community-led mapping in Mathare settlement. They are planning how to make their inquiries into community issues deeper by creating spaces for wider community interactions through forums and debates around the films that are made.

Participatory visual processes can reveal and communicate powerfully about experiences from the margins by providing contextualised examples of the complex and subjective aspects and consequences of development. It will be really interesting to see how the use of video develops in both organisations and across the initiative, and also how the various actors in this post-2015 debate respond to making a very real, very human connection with people living in poverty.

Thea Shahrokh is a Research Officer in the Participation, Power and Social Change research team at IDS.

Read other recent blogs by Thea Shahrokh: