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Health Equity in Kenya: Urban vs Rural, Informal Settlements

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Easy Access Staff

What Is Health Equity?

Health equity means everyone has a fair chance to be as healthy as possible, regardless of where they live, how much money they have, or their background.

Health inequity means some groups face bigger barriers to good health than others.

In Kenya: Where you live and your economic status significantly affect your access to quality healthcare.

Health Disparities in Kenya

Urban vs Rural

Urban areas (Nairobi, Mombasa, Kisumu) generally have:

  • More hospitals and health facilities
  • More doctors and specialists
  • Better equipped facilities
  • Shorter distances to care
  • More health insurance coverage

Rural areas face:

  • Fewer health facilities (long distances)
  • Shortage of healthcare workers
  • Limited equipment and supplies
  • Poor roads (hard to reach facilities)
  • Lower insurance coverage

Example: Nairobi County has 1 doctor per 1,000 people. Some rural counties have 1 doctor per 20,000+ people.

Informal Settlements (Slums)

Challenges in places like Kibera, Mathare, Mukuru:

  • Overcrowding (disease spreads fast)
  • Poor sanitation (no toilets, dirty water)
  • Limited access to health facilities
  • Can’t afford healthcare costs
  • Insecure housing (evictions disrupt care)
  • High rates of HIV, TB, malnutrition

Paradox: Living in a city but facing rural-level health challenges.

Wealth and Income

Wealthier Kenyans:

  • Can afford private healthcare
  • Have health insurance
  • Can travel to better facilities
  • Afford medications and tests
  • Better nutrition and living conditions

Poorer Kenyans:

  • Depend on public facilities (often overwhelmed)
  • May skip care due to cost
  • Can’t afford medications
  • Live in conditions that make illness more likely
  • Work in dangerous or unhealthy jobs

Regional Disparities

Central Kenya, Nairobi: Better health outcomes

North Eastern, Coast, parts of Nyanza and Western: Worse health outcomes

Why?

  • Historical underdevelopment
  • Less infrastructure
  • Poverty
  • Insecurity (in some areas)
  • Nomadic lifestyles (harder to access fixed facilities)
  • Cultural practices affecting health-seeking

Specific Health Disparities

Maternal and Child Health

Urban vs Rural:

  • Rural women less likely to deliver in a facility
  • Higher maternal death rates in rural areas
  • More children in rural areas miss vaccinations
  • Rural children face more malnutrition

Why?

  • Distance to facilities
  • Lack of ambulances
  • Cultural preference for traditional birth attendants
  • Poverty (can’t afford transport to hospital)

Infectious Diseases

Malaria:

  • More common in Western Kenya, Coast, parts of Rift Valley
  • Less common in Central Highlands and Nairobi (cooler climates)

HIV/AIDS:

  • Higher rates in Nyanza, Nairobi, Coast
  • Stigma worse in rural areas (people avoid testing)

TB:

  • Higher in informal settlements (overcrowding)
  • Worse outcomes in areas with poor healthcare access

Non-Communicable Diseases (NCDs)

Rising everywhere, but:

  • Urban areas: More diabetes, hypertension, heart disease (sedentary lifestyles, processed foods)
  • Rural areas: Often undiagnosed (no screening), worse outcomes when diagnosed

Mental Health

Rural areas:

  • Very few mental health services
  • More stigma
  • Reliance on traditional healers or churches
  • People suffer in silence

Urban areas:

  • More services available (but still insufficient)
  • Less stigma (slowly improving)
  • Stress from urban life high

Informal settlements: High mental health burden, very limited services

Barriers to Healthcare Access

Geographic Barriers

Long distances:

  • Some Kenyans walk 10-20 km to nearest health facility
  • Emergencies become fatal due to distance
  • Pregnant women can’t reach hospital in time

Poor roads:

  • Ambulances can’t reach remote areas
  • Transport costs increase during rainy season

Solution efforts:

  • Building more dispensaries and health centers
  • Community health workers bringing care closer
  • Telemedicine (where infrastructure allows)

Financial Barriers

User fees (though reduced):

  • Even small fees prevent poorest from seeking care
  • Choosing between food and healthcare

Indirect costs:

  • Transport to facility
  • Lost income from missing work
  • Accommodation if referred to distant hospital

Medication costs:

  • Stock-outs in public facilities force buying from private pharmacies
  • Can’t afford full treatment course

Solution efforts:

  • SHA/SHIF aims to remove financial barriers
  • Free maternal and child health services
  • Free HIV and TB treatment

Health System Barriers

Shortage of healthcare workers:

  • Doctors and nurses concentrated in urban areas
  • Rural facilities understaffed
  • Long wait times everywhere

Facility challenges:

  • Lack of equipment
  • Medication stock-outs
  • Poor infrastructure (no water, electricity)
  • Overcrowding

Quality of care:

  • Rushed consultations
  • Misdiagnosis
  • Disrespectful treatment
  • Corruption (demanding bribes)

Social and Cultural Barriers

Gender inequality:

  • Women need male family member’s permission for care
  • Women’s health needs neglected
  • More girls than boys miss vaccinations in some communities

Cultural beliefs:

  • Preference for traditional healers
  • Harmful practices (FGM, child marriage)
  • Stigma around certain diseases (HIV, mental illness)
  • Misconceptions about Western medicine

Language:

  • Health workers speak Swahili or English
  • Patients speak only local languages
  • Communication breakdowns lead to poor care

Education:

  • Low health literacy
  • Don’t recognize danger signs
  • Don’t understand disease prevention
  • Can’t navigate health system

Disability and Health Access

People with disabilities face additional barriers:

Physical barriers:

  • Facilities not wheelchair accessible
  • No ramps, lifts, or accessible toilets
  • Examination tables too high
  • No sign language interpreters

Attitudinal barriers:

  • Healthcare workers lack training on disability
  • Dismissive attitudes
  • Assumptions about capabilities

Financial barriers:

  • Higher healthcare needs, higher costs
  • Assistive devices expensive
  • Need attendants (extra cost)

Result: People with disabilities have worse health outcomes and shorter life expectancy.

What’s Being Done

Government Initiatives

1. Devolution:

  • Counties now manage healthcare
  • Should bring services closer
  • Mixed results so far (depends on county)

2. Universal Health Coverage (UHC):

  • Goal: Healthcare for all Kenyans
  • SHA/SHIF implementation ongoing
  • Challenges with funding and implementation

3. Free Services:

  • Maternal and child health free
  • HIV and TB treatment free
  • Reduces financial barriers

4. Community Health Strategy:

  • CHPs/CHVs bring care to homes
  • Especially important in rural and informal areas

5. Linda Mama Program:

  • Free maternity services
  • Reduced maternal deaths
  • More facility deliveries

County-Level Efforts

Some counties doing well:

  • Building new health facilities
  • Employing more healthcare workers
  • Providing ambulances
  • Mobile clinics for remote areas

Challenges:

  • Depends on county leadership and resources
  • Some counties doing much better than others

NGOs and Partners

Many organizations working to reduce disparities:

  • Building clinics in underserved areas
  • Training healthcare workers
  • Providing equipment and supplies
  • Running mobile clinics
  • Health education campaigns
  • Advocacy for marginalized groups

Private Sector

Some positive contributions:

  • Private hospitals in rural areas
  • Affordable clinic chains
  • Telemedicine expanding access
  • Health insurance products

But: Private care still unaffordable for most Kenyans.

What Needs to Improve

More Healthcare Workers

Need:

  • Train more doctors, nurses, clinical officers
  • Incentivize working in rural areas
  • Improve working conditions
  • Fair distribution across counties

Better Infrastructure

Need:

  • Build/renovate facilities
  • Ensure water, electricity, equipment
  • Stock medications reliably
  • Improve roads for access

Stronger Primary Care

Need:

  • Invest in dispensaries and health centers
  • Prevent overload at hospitals
  • Community health programs

Address Social Determinants

Healthcare alone isn’t enough. Need:

  • Better housing (especially informal settlements)
  • Clean water and sanitation
  • Nutrition programs
  • Education
  • Economic opportunities
  • Gender equality
  • Peace and security

Data and Monitoring

Need:

  • Track health outcomes by region, wealth, gender
  • Identify gaps
  • Hold systems accountable
  • Adjust programs based on data

What You Can Do

Advocate

Individual level:

  • Vote for leaders who prioritize health equity
  • Speak up about poor healthcare experiences
  • Report corruption or mistreatment
  • Support health-focused organizations

Community level:

  • Join or form health committees
  • Hold county health officials accountable
  • Share health information in your community
  • Support vulnerable neighbors

Support Those Facing Barriers

Help neighbors who:

  • Can’t afford transport to clinic
  • Need someone to watch children while they seek care
  • Don’t understand how to access services
  • Face language barriers
  • Have disabilities

Use Available Services

Even if access is hard:

  • Register for SHA/SHIF
  • Use free services (maternal/child health, HIV, TB)
  • Go to community health workers
  • Attend health talks and screenings
  • Seek care early (don’t wait)

Educate Yourself and Others

Learn about:

  • Disease prevention
  • Nutrition and hygiene
  • When to seek care
  • Your health rights
  • Available services

Share knowledge with family, friends, community.

Success Stories

Reduced Maternal Deaths

  • More skilled birth attendants
  • More facility deliveries
  • Ambulances in some counties
  • Maternal deaths dropping (still too high, but improving)

HIV Control

  • Free testing and treatment nationwide
  • Stigma slowly reducing
  • People living longer, healthier lives with HIV

Immunization

  • Most children now vaccinated
  • Diseases like polio eliminated
  • Mobile clinics reaching remote areas

Community Health

  • CHPs/CHVs reaching millions
  • Early disease detection
  • Health education in homes

These show progress is possible when we prioritize equity.

The Vision: Health for All

Imagine a Kenya where:

  • Every woman delivers safely, regardless of location
  • Every child gets vaccinated
  • No one dies from preventable diseases
  • Mental health care is accessible and stigma-free
  • Disabilities don’t limit healthcare access
  • Wealth doesn’t determine health outcomes
  • Quality care is available everywhere

This is possible. It requires:

  • Political will
  • Adequate funding
  • Community involvement
  • Holding leaders accountable
  • Each of us doing our part

Take Action Today

Know Your Rights

You have the right to:

  • Access healthcare regardless of where you live
  • Respectful treatment
  • Quality care
  • Emergency services
  • Free maternal and child health services

If denied: Report to facility in-charge, county health office, or Kenya National Commission on Human Rights.

Get Involved

  1. Register for SHA/SHIF (helps fund system)
  2. Participate in community health activities
  3. Support vulnerable community members
  4. Vote for leaders committed to health equity
  5. Report health system failures
  6. Advocate for better services in your area

Health equity means everyone—urban or rural, rich or poor, abled or disabled—gets the care they need to be healthy. We’re not there yet in Kenya, but progress is happening. Stay informed, use available services, and demand better for yourself and your community.