How gender data elevated community health worker impact during Mathare floods

 

a Mathare residential area which was flooded as a result of heavy rains 

Desperate wails rent the air and people shouted urgent instructions as they tried to save more people, tragically including children, from being swept away by the raging waters of Mathare River.

The River had burst its banks in the middle of the night catching residents of the surrounding informal settlement unaware and completely upending their homes, and, for many, their lives.

This was the scene in Mathare, an informal settlement in Nairobi, Kenya's capital city, in the wee hours of April 23rd 2024.

Isabella Nzioki, a Community Health Promoter (CHP) and resident of Mathare has been working with people living with HIV/Aids in the area for more than five years.

Trained in HIV/Aids care including helping patients to remain compliant with medication (defaulter-tracing), mentorship, and TB social care, Isabella, a mother of two, is passionate about contributing to the welfare of her community especially given the numerous challenges they face as residents of Mathare. 

Mathare is a collection of informal settlements in Nairobi and home to an estimated 500,000 people. It is one of the largest informal settlements in Nairobi, Kenya’s capital city.

Roughly 180,000 people live in Mathare Valley alone, which is among the oldest of the informal settlements that fall under the name Mathare. It is adjacent to Mathare River.

In March 2024, Isabella was one of five grassroots community members drawn from Nairobi and neighbouring counties, who shared their experiences on the use of gender data and statistics during a focus group discussion with UN Women.

The exploratory discussion was part of gathering stakeholders’ voices towards the development of a joint UN Women-GROOTS Kenya toolkit on the use of gender data in East and Southern Africa. 

By her affiliation with GROOTS Kenya, a national movement of grassroots women-led community-based groups (CBOs) and Self-Help Groups (SHGs), Isabella was selected to share her experiences with gender data, including data related to gender-based violence(GBV), which tends to be high in informal settlements where crime is often rife and overall security poor. 

Beyond gathering the five discussants’ views, the focus group discussion also helped to grow their understanding of why it is important to disaggregate data by sex and other variables such as age, disability status, location, HIV/Aids status, and even employment status. In effect, it built their knowledge and understanding of gender data. 

Little did Isabella know that just weeks later, with the onset of the March to May rains, her newly acquired appreciation for gender data would have life-changing effects on her community at the height of the 2023-2024 El Niño rains−termed by the UN as “one of the five strongest ever recorded”. 

According to government data, by mid-May 2024, floods from the pounding rains had killed at least 291 people in Kenya and displaced an estimated 47,000 households with at least 75 people still missing across the country. Nairobi was hardest hit with Mathare bearing the brunt of much of the destruction. 

“That first night, I was jolted awake by the sounds of iron sheets and wooden planks crashing and a strange sound I couldn't immediately recognise followed by the alarmed screams of neighbours,” Isabella said. 

“It took me a moment to understand what was happening only to realise that the River had burst its banks. That area is called Rūini (Kikuyu for “at the river”) and there are many houses down there."

The surging water was sweeping away many of the largely makeshift houses in the neighbourhood. 

Isabella was among neighbours who rushed to the aid of residents who were nearest the River, helping them shift to an ad hoc camp for the displaced in a nearby church on higher ground.

By the end of May, this was one of at least 115 camps set up across 19 counties hosting nearly 30,000 people.

Amidst the chaos of the night as residents desperately tried to save more people including children from being carried away by the raging water, Isabella, armed with a 32-page notebook she had recently acquired and a new understanding of gender data, began to record details of the survivors. 

“I recorded a total of 81 people who took shelter at the camp on just that first night,” Isabella said. 

“There were 64 women and some of them were pregnant. Others had very young children, many of whom were under the age of five years.” 

Isabella's in-depth knowledge of the community as a CHP and further on-site enquiries helped her to easily identify people living with HIV/Aids (PLWHIV/Aids), children suffering from diarrhoea, and even people with asthma or who frequently used inhalers to assist with breathing difficulties. 

This seemingly simple data proved invaluable. When Kenya Red Cross arrived in the early hours and sought information on how many children and pregnant women were in the camp, Isabella presented her data, which was used to deliver cooked food as immediate assistance. 

When AMREF arrived at the makeshift camp shortly after the disaster, Isabella’s data informed urgent and important decisions on the rapid establishment of a mobile clinic to effectively manage chronic and sensitive medical needs including medical assistance to a woman with cervical cancer who had excessive bleeding.

Even before humanitarian assistance arrived amidst the turmoil of the first night, using her data sheet, Isabella managed to secure short-term doses of antiretroviral medication (ARVs) from a nearby private health facility for identified PLWHIV/Aids. 

“Their medication had been washed away by the floods and it was important to me that they continue to stick to their treatment as they cannot afford to miss even a dose,” explained Isabella. 

She later used the same records to ensure continued medical support of PLWHIV/Aids at Huruma Lions Hospital, the nearby public health facility to which she is mapped as a CHP as part of supporting these patients’ compliance with the life-saving treatment.

Even though her house had survived the flood, through the harrowing first night, Isabella braved it out in the camp with neighbours whose houses had been destroyed. Sleeping on the cold floor did not deter her; she wanted to be at hand to help. 

When help came in the form of 20 initial mattresses, Isabella's data enabled humanitarian agencies to prioritize assistance and informed the critical decision of pregnant women and those with infants and children under the age of five being given mattresses first.

At some point, Isabella even presented the disaggregated data to the area chief at his request for further coordination with the government and assisting agencies. 

“I found the data very powerful when it came to prioritising help but also when managing complaints at the camp,” said Isabella. 

“In the early stages, when people at the camp would grumble about how mattresses or other resources were being allocated, I would just hold up my notebook and they would see the list of the highly vulnerable and quieten down. It was amazing that people could easily see that the allocations were fair and transparent and were then satisfied with the decisions being made.” 

The disaggregated data helped build even more trust between community members.

Isabella's compassionate act of spending nights in the camp with her neighbours inadvertently helped her to identify and document another critically vulnerable group of survivors who were bereaved and severely traumatised, including mothers whose young children had been snatched from their hands by the raging water.

This data again proved instrumental in escalating cases for counselling and psychosocial support from responding agencies in the following days. 

When government financial support of Sh10,000 (approximately $75 at the time) per household came through as part of flood assistance, Isabella’s records contributed to accurately identifying the affected as well as the most vulnerable households to properly direct the support.

Previously, it was not common to document issues including GBV in the community using gender or disaggregated data and Isabella did not understand or appreciate its use, least of all to make decisions.

“I was so impressed with how the use of this disaggregated data helped to address gaps between survivors and humanitarian agencies,” said Isabella. 

“By identifying survivors and their specific needs and helping those providing humanitarian assistance to properly direct their effort, it provided a quick and much-needed link.” 

by UN WOMEN