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Background: Quality pharmaceutical services are an integral part of primary healthcare and a key determinant of patient outcomes. The study focuses on pharmaceutical service delivery among private healthcare facilities serving informal settlements within Nairobi County, Kenya and aims at understanding the drug procurement practices, task-shifting and ethical issues associated with drug brand preference, competition and disposal of expired drugs. Methods: Forty-five private facilities comprising of hospitals, nursing homes, health centres, medical centres, clinics and pharmacies were recruited through purposive sampling. Structured electronic questionnaires were administered to 45 respondents working within the study facilities over an 8-week period. Results: About 50% of personnel carrying out drug procurement belonged to non-pharmaceutical cadres namely; doctors, clinical officers, nurses and pharmacy assistants. Drug brand preferences among healthcare facilities and patients were mainly pegged on perceived quality and price. Unethical business competition practices were recorded, including poor professional demeanour and waiver of consultation fees veiled to undercut colleagues. Government subsidized drugs were sold at 100% profit in fifty percent of the facilities stocking them. In 44% of the facilities, the disposal of expired drugs was not in conformity to existing government regulatory guidelines. Conclusions: There is extensive task-shifting and delegation of pharmaceutical services to non-pharmaceutical cadres and poor observance of ethical guidelines in private facilities. Strict enforcement of regulations is required for optimal practices.

The Nancy N. Boothe papers, 1980-2009 [bulk 1990-1997], are composed of articles, notes, reports and a wide variety of feminist publications. Much of the material documents the U.N. Fourth World Conference on Women, which Ms. Boothe attended as Executive Director of Atlanta's Feminist Women's Health Center. Artifacts, artwork and textiles relate to the conference and to other women's and health issues. ; Born in Battles Wharf, Alabama (1948), Nancy N. Boothe graduated from the University of South Alabama as a registered nurse (1971). She received a B.S. in nursing from the Medical College of Georgia (1976), and a master's degree in Counseling from Troy State University [Florida Region] (1981). Boothe served in the U.S. Nurse Corps in the U.S. and Korea (1970-1984), and worked as clinical director and consultant at a number of health facilities in Louisiana and Florida. She became Executive Director of the Atlanta Feminist Women's Health Center in 1994. In 1995, she attended the Fourth World Conference on Women in Beijing, China, where she taught the workshop, ""GYN Self-Help."" Boothe has served on the boards of All Women's Health Services in Portland and Eugene, Oregon; the Sexual Assault Center, Atlanta, Georgia; and the Jeanette Rankin Foundation, Athens, Georgia. She is also a member of the Feminist Majority Foundation's ""Women's Commission for Congressional Oversight"" and A.P.D. Citizen Review Panel.; Founded in California in 1971 by Carol Downer (1933-) and Lorraine Rothman (1932-2007), the Feminist Women's Health Center was established to empower women through self-knowledge, education and self-help groups. The Atlanta Feminist Women's Health Center was established in 1977. Its mission is to ""provide accessible, comprehensive gynecological healthcare to all who need it without judgment. As innovative healthcare leaders, [they] work collaboratively within [their] community and nationally to promote reproductive health, rights and justice. [They] advocate for wellness, uncensored health information and fair public policies by educating the larger community and empowering [their] clients to make their own decisions.""; The United Nations convened the Fourth World Conference on Women, September 4-15, 1995, in Beijing, China, with a Platform for Action that aimed at achieving greater equality and opportunity for women. Three previous World Conferences were held in Mexico City (International Women's Year, 1975), Copenhagen (1980) and Nairobi (1985). 189 governments and more than 5,000 representatives from 2,100 non-governmental organizations participated in the Beijing Conference. The principal themes were the advancement and empowerment of women in relation to women's human rights, women and poverty, women and decision-making, the girl-child, violence against women and other areas of concern. The resulting documents of the Conference are The Beijing Declaration and Platform for Action. The U.N. Fourth World Conference on Women manifested a global women's movement for change and has been called ""the Woodstock of the women's movement.""; The World Conference on Women was also accompanied by an informal meeting (August 30-September 8) of non-governmental organizations (NGOs). This NGO Forum on Women, Beijing '95, brought together thousands of women from around the world to exchange information and ideas, celebrate women's achievements and contributions and draw attention and develop solutions to discrimination facing women world-wide.

The Nancy N. Boothe papers, 1980-2009 [bulk 1990-1997], are composed of articles, notes, reports and a wide variety of feminist publications. Much of the material documents the U.N. Fourth World Conference on Women, which Ms. Boothe attended as Executive Director of Atlanta's Feminist Women's Health Center. Artifacts, artwork and textiles relate to the conference and to other women's and health issues. ; Born in Battles Wharf, Alabama (1948), Nancy N. Boothe graduated from the University of South Alabama as a registered nurse (1971). She received a B.S. in nursing from the Medical College of Georgia (1976), and a master's degree in Counseling from Troy State University [Florida Region] (1981). Boothe served in the U.S. Nurse Corps in the U.S. and Korea (1970-1984), and worked as clinical director and consultant at a number of health facilities in Louisiana and Florida. She became Executive Director of the Atlanta Feminist Women's Health Center in 1994. In 1995, she attended the Fourth World Conference on Women in Beijing, China, where she taught the workshop, ""GYN Self-Help."" Boothe has served on the boards of All Women's Health Services in Portland and Eugene, Oregon; the Sexual Assault Center, Atlanta, Georgia; and the Jeanette Rankin Foundation, Athens, Georgia. She is also a member of the Feminist Majority Foundation's ""Women's Commission for Congressional Oversight"" and A.P.D. Citizen Review Panel.; Founded in California in 1971 by Carol Downer (1933-) and Lorraine Rothman (1932-2007), the Feminist Women's Health Center was established to empower women through self-knowledge, education and self-help groups. The Atlanta Feminist Women's Health Center was established in 1977. Its mission is to ""provide accessible, comprehensive gynecological healthcare to all who need it without judgment. As innovative healthcare leaders, [they] work collaboratively within [their] community and nationally to promote reproductive health, rights and justice. [They] advocate for wellness, uncensored health information and fair public policies by educating the larger community and empowering [their] clients to make their own decisions.""; The United Nations convened the Fourth World Conference on Women, September 4-15, 1995, in Beijing, China, with a Platform for Action that aimed at achieving greater equality and opportunity for women. Three previous World Conferences were held in Mexico City (International Women's Year, 1975), Copenhagen (1980) and Nairobi (1985). 189 governments and more than 5,000 representatives from 2,100 non-governmental organizations participated in the Beijing Conference. The principal themes were the advancement and empowerment of women in relation to women's human rights, women and poverty, women and decision-making, the girl-child, violence against women and other areas of concern. The resulting documents of the Conference are The Beijing Declaration and Platform for Action. The U.N. Fourth World Conference on Women manifested a global women's movement for change and has been called ""the Woodstock of the women's movement.""; The World Conference on Women was also accompanied by an informal meeting (August 30-September 8) of non-governmental organizations (NGOs). This NGO Forum on Women, Beijing '95, brought together thousands of women from around the world to exchange information and ideas, celebrate women's achievements and contributions and draw attention and develop solutions to discrimination facing women world-wide.

This is a preliminary summary of some of the findings of the University of Nairobi Tracer Study. The focus of the study's questionnaire concerned employment and educational history following graduation

The rapid rise of the population in most developing countries has posed a challenge to respective governments to provide decent and quality social services to its populace as anchored in their constitutions. This increased population has superseded the existing social amenities such as houses, schools, and hospitals as planned by city planners. This has resulted in the proliferation of informal settlements, whose geographical locations are noted by a poor environment that has hostile living conditions to mankind. This paper elucidates that limited knowledge, pessimistic attitude from the locals, poor leadership, corruption, and lack of accountability are the causal factors for the continued pathetic status of Kibera slums. The paper thus concludes that if barriers that cause marginalization to the people are lifted, there is the accountability of service provision by relevant stakeholders, empowerment, and good leadership; Kibera will thrive and become one of the best places for human settlement.

Increase in disaster incidences have been witnessed in secondary schools in recent years, its frequency and impact hampering education process. For instance, besides loss of lives, and injuries, school properties have been damaged and closing and often with children having to leave school for long periods in recovery period. Continued occurrence and magnitude of disaster have prompted international organizations especially the United Nations agencies and other countries to come up with best practice models of institutions including training on disaster and disaster risk management. Despite the concerted efforts by the government of Kenya and other stakeholders in emphasizing preparedness, Kenya still experiences various disasters in schools. Majority of students in secondary schools are exposed to mishaps and accidents daily in schools. School authorities, parents and even students are jolted into actions only when a fatality or injury has occurred and this affects the response and mitigation level of these disasters and thus the need of the study. The general objective of the study is to assess disaster preparedness and safety standards in public secondary schools of Nairobi County, Kenya. The study sought to establish the level of disaster preparedness in public secondary schools in Nairobi County. The study adopted a descriptive research design. Target population of the study was 73 from which 13 schools were selected using random sampling. Data was collected using questionnaires, interview schedules, focus group discussions and observation checklist. From the findings, 10.16% (n=39) of the total population determining that schools conduct most frequent training, 13.02% (n=50) of the total population responded training programs are done frequently. 28.65 (n=110) of students indicated trainings on fire safety facilities are done less frequently. The findings revealed a lack of training and inadequate community awareness on disaster preparedness and safety standards. The study concluded that the schools were insufficiently prepared for disasters and most of the physical infrastructures were considered unsafe. The study recommended regular inspection of school infrastructure, safety training by qualified by qualified personnel and taking into consideration the ability and capacity of different schools when settings standards for disaster preparedness and safety.

This book was published by the Water, Engineering and Development Centre (WEDC) at Loughborough University. ; For centuries, Small Water Enterprises (SWEs) have supplied a large share of the water market in the urban centres of most low-income countries. Such SWEs have proved themselves economically viable, and often operate in competitive conditions. They extend water services to informal settlements that have little prospect of being supplied with piped water from the local utility. Unfortunately, they attract comparatively little investment, and even less support from governments. The incremental but critically important improvements they can provide tend to be overlooked by governments and international agencies. In international statistics any household that gets its water from vendors is defined as lacking access to improved water supplies. This book is one of the outputs from a project designed to identify and test out ways of improving the water services delivered to the urban poor through SWEs. As such, it will prove an invaluable resource for water utility managers and policymakers. The book includes accounts of fieldwork undertaken in a number of African cities: Dar es Salaam (Tanzania); Nairobi (Kenya); Khartoum (Sudan) and Accra (Ghana). Even in these cities, where dependence on SWEs is high, the services provided by these SWEs have been poorly documented until now.

Low-income households in Kenya depend on informal dairy sector to access raw milk and meet their nutrient needs. This is because raw milk is cheaper than processed milk by 20–50%; majority prefers its taste and high butterfat content; it is widely accessible; and it is sold in variable quantities suiting every consumer's affordability. Despite the critical nutritional role played by the informal dairy sector on poor households, the need to conform to international standards of food safety has triggered regulatory agencies to formulate policies that restrict informal commercialization of milk. While promoting milk pasteurization is an important public health measure, little is known of its potential effect on household milk consumption and allocation. Methods: We conducted an experimental study to investigate the effect of milk price increase on intra-household milk allocation to children (less than 4-year-old) in peri-urban settlements in Nairobi that would result from elimination of the cheaper informal milk from the market. The study entailed a best-worst choice experiment that posed various hypothetical scenarios, each with four milk allocation alternatives for the respondent to pick the most and least likely choices they would take in the event milk prices increased by 40% from the prevailing retail price. We analyzed the relative importance of milk allocation alternatives and used latent class model to examine the likely impact of such policy on children milk allocation in different groups. Findings and interpretations: Of all the 9 milk allocation alternatives, 4 were the most important/preferred regardless of the household socioeconomic and demographic characteristics and these suggested that an increase in milk price by 40%would decrease overall milk demand and consumption at the household level. Moreover, in three of those, the choices that households consider best/most likely directly affect the amount of milk allocated to children below the age of 4 years. Although participants indicated that they would compensate for the decreased milk amount allocated to children by substituting with another food item, the nutrition value of the replacement, taste and preference, complementarity and price among other factors might not match that of milk. Conclusions: Poor households prefer consuming raw milk sourced from the informal sector due to its relative affordable price, taste and its accessibility. Increasing price would likely decrease household demand as there would be overall decrease on the amounts consumed by its members – including children. Given that the current consumption is below the amounts recommended by WHO, policies streamlining the dairy sector should consider the large informal sector as a strategic partner and strengthen its capacity to market safe milk in an overarching goal of improving consumption instead of eliminating it. ; Government of the United Kingdom ; Bill & Melinda Gates Foundation

The dairy value chain of Nairobi is comprised, in its majority, of small-scale independent enterprises that operate within a complex interlinked system. In this complexity, the coordination and power structures of the system may have major influences on the management of dairy food safety. Therefore, the aim of this study was to investigate the governance structure and challenges faced by stakeholders throughout the Nairobi dairy value chain and assess their potential implications on food safety. Qualitative data were collected through focus group discussions and key informant interviews based on a dairy value chain mapping framework previously developed. Thematic analysis enabled identification of governance themes, key challenges and analysis of their implications on food safety. Themes were organized depending on their association with farmers (informal settlement or peri-urban), dairy cooperatives, dairy traders, processing companies, retailers or government officers. The identified governance themes included: i) weak linkage between government and farmers, ii) inadequate compliance with government regulations by traders and retailers, iii) emphasis on business licenses and permits for revenue rather than for food safety, iv) multiple licensing resulting in high business cost and lack of compliance, v) fragmented regulation, vi) unfair competition and vii) sanctions that do not always result in compliance. The key challenges identified included, among others: i) inadequate farmer support, ii) harassment of traders and retailers and iii) high business costs for traders, retailers, dairy cooperatives and large processors. The implication of governance and challenges of food safety were, among others: i) inadequate extension services, ii) insufficient cold chain, iii) delivery of adulterated and low milk quality to bulking centers, iv) inadequate food safety training and v) lack of policies for management of waste milk. The range of issues highlighted are based on stakeholders' perceptions and reflects the complexity of the relationships between them. Many of the governance themes demonstrate the linkages that are both beneficial or confrontational between the formal and informal sectors, and between industry and regulatory authorities, with possible direct food safety consequences. Findings obtained provide indications to decision-makers of potential governance areas that could help improve efficiency and food safety along the dairy value chain. ; Medical Research Council, United Kingdom ; Biotechnology and Biological Sciences Research Council, United Kingdom ; Natural Environment Research Council, United Kingdom ; Economic and Social Research Council, United Kingdom ; Peer Review

Urban livestock keeping in developing cities have an important role in food security and livelihoods, but can also pose a significant threat to the environment and health of urban dwellers. The aim of this study was to identify the different livestock systems in Nairobi, their supply chains and their management and food safety risks. Seven focus group discussions with Livestock production officers in charge of each major Nairobi subcounty were conducted. Data were collected on the type of systems existing for each livestock species and their supply chains, disease management, food safety risks, and general husbandry and gender factors. Supply chain flow diagrams and thematic analysis of the data was done. Results of the study show a large variability of livestock keeping in Nairobi. The majority were small scale with: <5 dairy cows, 1-6 dairy goats, <10 small ruminants, <20 pigs, 200-500 broilers, 300-500 layers, <10 indigenous chickens or <20 rabbits. Beef keeping was mainly described as a 'by the way' system or done by traders to fatten animals for 3 month. Supply chain analysis indicated that most dairy farmers sold milk directly to consumers due to 'lack of trust' of these in traders. Broiler and pig farmers sold mainly to traders, but are dependent on few large dominating companies for their replacement or distribution of products. Selling directly to retailers or consumers (including own consumption), with backyard slaughtering, were important chains for small scale pig, sheep and goat and indigenous chicken keepers. Important disease risk practices identified were associated to consumption of dead and sick animals, with underground network of brokers operating for ruminant products. Qualified trained health managers were used mainly by dairy farmers, and large commercial poultry and pig farmers, while use of unqualified health managers or no treatment were common in small scale farming. Control of urban livestock keepers was reported difficult due to their 'feeling of being outlaws', 'lack of trust' in government, 'inaccessibility' in informal settlements, 'lack of government funding' or 'understaffing'. Findings are useful for designing policies to help to control urban livestock production and minimize its associated health and environment risks. ; Medical Research Council, United Kingdom ; Natural Environment Research Council, United Kingdom ; Economic and Social Research Council, United Kingdom ; Biotechnology and Biological Sciences Research Council, United Kingdom ; Peer Review

The dairy value chain of Nairobi is comprised, in its majority, of small-scale independent enterprises that operate within a complex interlinked system. In this complexity, the coordination and power structures of the system may have major influences on the management of dairy food safety. Therefore, the aim of this study was to investigate the governance and challenges issues faced by stakeholders throughout the Nairobi dairy value chain and assess their potential implications on food safety. Qualitative data was collected through focus group discussions and key informant interviews based on a dairy value chain mapping framework previously developed. Thematic analysis enabled identification of governance themes, key challenges and their implication on food safety. Themes were organized depending on their association with farmers (informal settlement or peri-urban), dairy cooperatives, dairy traders, processing companies, retailers or government officers. The identified governance themes included: i) weak linkage between government and farmers, ii) inadequate compliance with government regulations by traders and retailers, iii) emphasis on business licenses and permits for revenue rather than for food safety, iv) multiple licensing resulting in high business cost and lack of compliance, v) fragmented regulation, vi) unfair competition and vii) sanctions that do not always result in compliance. The key challenges identified included, amongst others: i) inadequate farmer support, ii) harassment of traders and retailers and iii) high business costs by traders, retailers, dairy cooperatives and large processors. The implication of governance and challenges of food safety were, amongst others: i) inadequate extension services, ii) insufficient cold chain, iii) delivery of adulterated and low milk quality to bulking centres, iv) inadequate food safety training and v) lack of policies for management of waste milk. The range of issues highlighted are based on stakeholders' perceptions and reflects the complexity of the relationships between them. Many of the governance themes demonstrate the linkages that are both beneficial or confrontational between the formal and informal sectors, and between industry and regulatory authorities, with possible direct food safety consequences. Findings obtained provide indications to decision-makers of potential governance areas that could help improve efficiency and food safety along the dairy value chain.

There is mounting concern about declines in wildlife populations in many protected areas in Africa. Migratory ungulates are especially vulnerable to impacts of changing land use outside protected areas on their abundance. Range compression may compromise the capacity of migrants to cope with climatic variation, and accentuate both competitive interactions and predation. We analyzed the population dynamics of 11 ungulate species within Kenya's Nairobi National Park, and compared them to those in the adjoining Athi-Kaputiei Plains, where human settlements and other developments had expanded. The migratory wildebeest decreased from almost 30,000 animals in 1978 to around 5,000 currently but the migratory zebra changed little regionally. Hartebeest, impala, eland, Thomson's gazelle, Grant's gazelle, waterbuck, warthog and giraffe numbers declined regionally, whereas buffalo numbers expanded. Bimonthly counts indicated temporary movements of several species beyond the unfenced park boundaries, especially during very wet years and that few wildebeest entered the park during the dry season following exceptionally wet conditions in 1998. Wildebeest were especially vulnerable to anthropogenic impacts in their wet season dispersal range on the plains. Deterioration in grassland conditions in the park following high rainfall plus lack of burning may have discouraged these animals from using the park as a dry season refuge. Our findings emphasise the interdependency between the park and the plains for seasonal wildlife movements, especially in exceptionally dry or wet years. To effectively conserve these ungulates, we recommend implementation of the new land-use plan for the Athi-Kaputiei Plains by the county government; expansion of the land leasing program for biodiversity payments; collecting poacher's snares; negotiation and enforcement of easements, allowing both wildlife and livestock to move through the Athi-Kaputiei Plains, providing incentives for conservation to landowners; and improving grassland conditions within the park through controlled burning so that more wildlife can gain protection there.

Cities are made up of assemblages of incoherent wholes which co-exist together in a seemingly placid or tolerating mode of existence. Due to their nature and neo-liberalist policies governing them, the urban services are assumed to be provided in the right quantities and the right time for all, which is not always the case as many interests are at play contesting the powers that are. Water – a basic good and right enshrined in many nations' constitutions is still a far cry for all, is at the crux of this thesis in which a case study of Soweto East – a routinely marginalized heavily contested 'ghetto' space in which the residents have suffered historical neglect and injustice in the provision of basic urban goods and services and a site of several failed development interventions which foster urban injustice and further entrench the lack of the right to dwell in the city- has been used to depict the governance of a water system to ensure resilience and sustainability in the wake of the Sustainable Development Goals. Using the Governance Analytical Framework, this thesis unpackages the contested s(p)laces where dwellers have democratically organized themselves to take charge of their destiny by creating systems that utilize both the statutory norms and informal norms in differing measures to ensure that they can lay claim on water services. The system boasts of a rich interwoven tapestry of both historical and current claims for its being. The research explores the different roles and relationships existing between the various actors who move in between discourses of the local realities, relying on their local political economy to define or adapt to the actualization of the basic human right to a descent livelihood in the city and minimize the scarcity of these urban goods and services. Mixed method research infused with ethnography and archival material demonstrated the unique governance features of this particular system which is a model of a non-conformist emergent space where the dwellers are critical in ...