As part of our dissemination activities for the Royal Society ‘People and the planet’ report, Sir John Sulston FRS and I visited Nairobi for a series of meetings with policymakers and a public lecture at the University of Nairobi. While we were there, the African Population and Health Research Centre and the African Institute for Development Policy arranged for us to visit the informal settlement (or ‘slum’) of Korogocho. The slum is home to around 150,000 people over a space of about 1.5km2 and is situated close to the city’s main rubbish dump site. The people living here face many challenges, including extreme poverty, hunger and security issues. Unemployment rates are high with around 32% of people receiving no income[i] . Poor hygiene and sanitation mean that cholera, typhoid and dysentery are widespread. There is also a high HIV+ prevalence rate at around 14%[ii].
When you walk around Korogocho you can’t help but notice that there are lots of children. At 3.7, the total fertility rate in Korogocho is lower than the national average of 4.6 but higher that the average of Nairobi, which is at around 2.7 children per woman. With life expectancy at around 39 years, the youth dependency ratio is high, which means that there is a higher proportion of young dependents to those of working age.
The area Chief, Nyabuto Omache, gave us a tour of the slum and told us about some of the schemes in place to try to tackle the most pressing issues in this area. He took us to the ‘Big Pen Academy’ primary school, which was established in 1993 in response to the growing number of children who were not in primary education. Korogocho has two Government primary schools but there are more children in the slum than there are spaces at the schools. The Big Pen Academy now has 560 pupils and 13 teachers. We visited one of the classrooms and all present were shocked to learn that 45 students fit in the tiny space. It’s hard to imagine how any one of these students is going to be able to study hard enough to win a place at one of the non-fee paying secondary schools. Head Teacher, Emily Anzaya, confirmed that this rarely happens.
We also visited the ‘Family Hope Charity’, where Florence Akinyi, Assistant Chair, told us that the group was formed in 2008 to improve the welfare of HIV+ women in the community by generating savings. It was very clear that these women give a lot of support and optimism to each other. One of the group’s members, Njoki, took us to her house and told us her story. She lives in a small room with her two children and her sister. They are all HIV+. Njoki and her sister are both sex workers. They often have no money for food. The children are teased by other kids in the community because they take antiretroviral drugs. The sisters’ mother was also HIV+ and used to be a member of the Family Hope Charity but recently died. It’s hard to see how this family would survive without this support network.
Our visit to the Korogocho slum was thought-provoking on many levels. The Kenyan Government are trying hard to overcome some of the challenges present in this area, but there’s a long way to go. The international community needs to get behind attempts to address these kinds of situations. Population dynamics were absent from the Millennium Development Goals and access to family planning was only added at a later date. If population dynamics are not central to the post-2015 development framework then the international community has no hope of achieving the goals of sustainable development. If we don’t base targets on how the world will look in the future, then we can’t hope to provide food, education and other services to all people. And if sexual and reproductive healthcare, including family planning, is not universally available then we cannot hope that individuals will flourish.