Initiative description

Background and context

The World Health Organisation (WHO) officially declared Covid-19 as a pandemic on 11 March 2020. In Kenya, the disease was first detected in Nairobi in March 2020, spreading quickly through community transmission.

The Kenyan government launched a nationwide media campaign to inform citizens about handwashing, maintaining distance and related strategies to manage the pandemic. The Kenyan Ministry of Health (MOH) led a Covid-19 taskforce to steer the country’s prevention, containment and mitigation measures. However, a fragile healthcare system and large proportion of city residents living in informal settlements – with high levels of overcrowding, inadequate water and sanitation facilities, and intense levels of social mixing – placed Nairobi’s low-income residents at a higher risk. The government response was to put in place strict control measures, including a dusk-to-dawn curfew, prohibiting large gatherings, closing businesses and markets and restricting movement, all of which disproportionately penalised the city’s low-income population. The ban also included mass prayers, large weddings and funerals.

The pandemic and its consequent restrictive measures posed significant risks to both the health and livelihoods of informal settlements residents in Kenya’s urban centres. Initially, informal settlement communities in Nairobi considered Covid-19 as a problem for the “Western world” and well-to-do Kenyans who could afford international flights – until people in the community began to be infected and die, especially community health volunteers (CHVs), and the pandemic became more than a health threat, as restrictions led to major losses of jobs and income. Additionally, the government’s preventive strategies securitised enforcement (putting more police force in the street), especially to enforce curfews, and this resulted in escalating police brutality and deaths, especially young men in informal settlements (Sperber, 2020).

Coinciding with the pandemic, there was a significant recentralisation of Nairobi’s governance in 2020 and related shifts in service delivery to informal settlements. On 25February 2020, then-President Uhuru Kenyatta created Nairobi Metropolitan Services (NMS) and transferred key functions from the County Government to the military-led centralised agency, including health services and public works, utilities, and ancillary services (K'Akumu, 2022; Ouma, 2023). Although NMS was intended to improve service delivery and address longstanding corruption in Nairobi, major concerns subsequently emerged, such as large-scale evictions, elite accumulation and rising police brutality linked to heavy-handed Covid responses (ibid.; Sperber, 2020). At the same time, NMS did implement several initiatives in Nairobi’s informal settlements, including free water provision and improved handwashing stations, although as many as 55 million litres of free water were later flagged as missing.[1] Below, we explain how official actors could sometimes collaborate effectively with grassroots organisations in Nairobi’s informal settlements, while also acknowledging the challenges linked to Covid-19 relief distribution and the longstanding social, political and economic exclusions in low-income areas.

The Muungano Alliance (or “Alliance”) represents the combined force of (a) the Kenyan federation of slum dwellers (Muungano wa Wanavijiji, meaning “united slum dwellers” in Kiswahili, a grassroots social movement); (b) Akiba Mashinani Trust, the Kenyan federation’s urban poor fund; and (c) SDI Kenya, an NGO providing professional and technical support to the federation. This case study describes some of the many ways in which the Alliance stepped in to support the Covid-19 response in the informal settlements where they had a presence – including (1) through social mobilisation of its 100,000 members nationally across nearly 1,000 groups; (2) by making use of its rich database of community-led slum profiles and data (preexisting as well as new data collected in real time as the virus spread throughout the country); and (3) capitalising on a long history of collaboration with government and non-state actors to advance priorities such as improving access to WASH, promoting recognition for grassroots data and laying the groundwork for future interventions in informal settlements.

[1]See https://nation.africa/kenya/counties/nairobi/queries-after-55-million-litres-of-free-covid-19-water-go-missing-in-nairobi-4124406 (accessed 13 February 2024).

Summary of initiative

The Muungano Alliance’s response to Covid-19 focused on three areas: (1) raising awareness of Covid-19 prevention, (2) creating/strengthening partnerships and mapping, and (3) campaigning for social protection, including for CHVs.

1. Covid-19 prevention awareness.

In the wake of the pandemic, the Muungano Alliance distributed soap and masks to informal settlement communities in four counties (Nairobi, Machakos, Kisumu and Nakuru), handwashing stations to informal settlement communities in three counties (Nairobi, Kisumu and Nakuru) and personal protective equipment (PPE) kits consisting of masks, pocket sanitisers and gloves to CHVs in various Nairobi settlements. Overall, over 2,000 handwashing stations, 1,000 litres of handwashing soaps and 500 litres of sanitisers were donated. The federation was active in producing and disseminating Covid-19 information, both physically in informal settlements and online through social media; and in distributing educational fliers and posters containing information about symptoms, prevention and care, which were translated into local languages and also made available online for free download. Later, when Covid-19 vaccines became available, the Alliance worked to sensitise informal settlements communities to get vaccinated and contributed to efforts to debunk vaccine misinformation.

2. Partnerships and settlement mapping

When the pandemic hit, the Muungano Alliance capitalised on its relationships with the Nairobi City County government and recently founded (but now defunct) Nairobi Metropolitan Services (NMS). Strong relationships had been built during the 2017-19 Mukuru Special Planning Area (SPA) upgrading initiative, a large-scale, integrated development planning process, as well as during other previous engagements with local authorities. In particular, the Mukuru SPA collaboration with the NMS health department facilitated the Alliance’s nomination to and representation on the national Covid-19 taskforce (formal title “Informal Settlements Sub-committee to the National Covid-19 Technical Working Group”). The government’s key rationale for the Alliance’s inclusion in the taskforce was the rich data it had collected about informal settlements in major cities across Kenya.

A seat on the national Covid-19 taskforce provided the opportunity for the Muungano Alliance to be recognised as a key development partner and build relationships with other development partners supporting the government response, such as AMREF, Red Cross and UN agencies. For example, the Alliance partnered with the World Bank and JICA to identify Covid-19 hotspots and conduct risk-mapping in Nairobi and Mombasa. The Alliance’s spatial and sociodemographic data about informal settlements were recognised by the authorities. And it was an opportunity for the Alliance to advocate for integrating health issues in planning for informal settlement improvements.

Through its platform on the Covid-19 taskforce, the Muungano Alliance also helped to change the government’s unrealistic requirements for isolation and quarantine. Crowded and dense living conditions make home-based isolation impossible for most informal settlement residents. Instead, the Alliance, in collaboration with the national taskforce, worked to develop realistic guidelines on how to implement isolation centres, for use by informal settlement residents who tested positive with Covid-19. Using its existing settlement profile data, the Alliance then identified and mapped existing facilities that had the potential to be used as local isolation centres (such as schools, church halls or health centres). This was done for six informal settlements in Nairobi County, nine informal settlements in Kisumu County, and in two sub-counties in Mombasa County. Although community isolation centres were not used effectively in Kenya’s pandemic response, the Alliance’s advocacy nevertheless resulted in changes to official policy and guidelines.

In May and June of 2020, the Alliance also undertook an intensive exercise to collect situational data, with the aim of informing the national taskforce to aid decisionmaking. They conducted surveys periodically (every two to three days) to track Covid-19 testing, cases and deaths, and prevention and response activities. The survey covered ten informal settlements across three Kenyan counties (Nairobi, Kisumu and Naivasha). Data collection was undertaken by trained federation community mobilisers, who live in the informal settlements. Rapidly produced survey reports were then shared on the Muungano Alliance website and with the Ministry of Health and the taskforce.

3. Social protection and data collection

Some months into the pandemic, the state started providing social protection stipends to segments of the Kenyan population considered vulnerable (that is, people living with disabilities, those with HIV/AIDS and other chronic diseases, orphans and the elderly). This was implemented through local administrations (chiefs and village elders, community health volunteers, and Nyumba Kumi[1] heads). The government also rolled out a cash-for-work programme for unemployed youth, called Kazi Mtaani. However, reports showed that the targeting process for both initiatives was riddled with corruption, nepotism and exclusion of many vulnerable households. For example, analysis has indicated that the Covid-19 cash transfer programme provided support to less than 5% of Nairobi’s socioeconomically vulnerable families (Human Rights Watch, 2021). Meanwhile, non-state relief efforts were also present, and the Muungano Alliance supported GiveDirectly, a UK charity, in identifying 50,000 vulnerable households in need of support.

In September 2019, shortly before the pandemic, SDI Kenya and Muungano wa Wanavijiji had undertaken a data collection exercise focused on CHVs in the Mukuru Spatial Planning Area. This was done in collaboration with ARISE (Accountability and Responsiveness in Informal Settlements for Equity), a research programme funded by the UK government and led by the Liverpool School of Tropical Medicine.[2] The mapping revealed the challenges the health workers face, such as training gaps and lack of remuneration. It exposed the widespread misallocation of CHVs based in informal settlements: in settlements like Mukuru, one CHV is responsible for 800 households, while in other areas they are only expected to cover 50 households. Subsequently, the Muungano Alliance presented their findings to government officials through the Informal Settlements Sub-committee to the National Covid-19 Technical Working Group. On the basis of this, the MOH recruited more CHVs for informal settlements, offered them additional Covid-19 training and ramped up efforts to register vulnerable households in Mukuru with CHVs.

The Alliance’s CHV mapping also contributed to the advocacy efforts of many agencies, which, in June 2021, led to the passing of the Nairobi City County Community Health Services Act – an important milestone in recognising CHVs’ vital role in complex and challenging urban environments, beyond just the Covid pandemic. The bill entitles Nairobi’s previously unpaid CHVs to receive a monthly stipend of KES 3,000 (about $30 USD) plus a further KES 500 ($5 USD) National Health Insurance Fund contribution. The payment is compensation for eight days’ work per month by CHVs and for meeting 80% of their performance targets relating to household visits, referrals, participation in community mobilisation and reporting. The passing of the Nairobi City County Community Health Services Act in June 2021 entitled 50,000 Nairobi County CHVs to a social protection stipend.

[1] Local safety committees with ten household representation structures (nyumba kumi means “ten houses” in Kiswahili).

[2] See www.ariseconsortium.org/our-approach/where-we-work/kenya-2/ (accessed 13 February 2024).