“The system brought beauty to our community”: Evaluating the impact of a physical address system in Mathare informal settlement, Nairobi, through ripple effect mapping
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Abstract
Introduction: Rapid urbanisation in Nairobi has led to the growth of informal settlements, characterised by overcrowding, poor infrastructure, and limited access to basic services. Often invisible in formal systems, these areas face weak accountability and restricted service access, worsening health and wellbeing. This paper evaluates the impact of a community-led Physical Address System (PAS) in improving visibility, access, and support for residents in the settlement of Kiamutisya in Mathare, Nairobi.
Methods: Drawing on community-led data collection, the PAS introduced a unique address for each physical structure in Kiamutisya to support service delivery and emergency response, addressing the invisibility that residents face. We held three Ripple Effect Mapping (REM) workshops with community leaders, community health promoters and Accountability and Responsiveness in Informal Settlements for Equity (ARISE) Hub co-researchers. REM is a participatory evaluation method that captures the impacts of an intervention, both intended and unintended, from the perspective of the community. Data was coded using NVivo 12 and analysed thematically.
Results: The PAS evaluation found direct impacts like better service delivery by community health promoters, and indirect benefits including stronger community identity, improved safety, and government engagement. It also noted ethical risks like data misuse and resident stigmatization. Key recommendations for policymakers and planners include using physical addresses to enhance service delivery and emergency response, formally integrating addresses into planning systems, and fostering community participation to improve equity in challenging urban environments.
Conclusions: This study underscores the potential of community health systems to address structural vulnerabilities and build resilience in informal settlements. The PAS demonstrates the value of participatory approaches in creating sustainable, scalable models for urban health, reinforcing the critical role of communities as active agents in advancing health and well-being.
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References
Accountability and Responsiveness in Informal Settlements for Equity (ARISE). Improving accountability for equitable health and well-being in urban informal spaces: Moving from dominant to transformative approaches. Prog Dev Stud. 2024; 24(4).
Karuga R, Kabaria C, Chumo I, Okoth L, Njoroge I, Otiso L, et al. Voices and challenges of marginalized and vulnerable groups in urban informal settlements in Nairobi, Kenya: building on a spectrum of community-based participatory research approaches. Front Public Health. 2023;11.
Kimani JS, Steege R, Makau, J, Nyambuga, K, Wairutu, J, Tolhurst, R. Building forward better: Inclusive livelihood support in Nairobi’s informal settlements. IDS Bull. 2021;52(1).
Chumo I, Kabaria C, Shankland A, Mberu B. Drivers of vulnerability to health and wellbeing challenges in informal settlements. Front Sustain Cities. 2023;5.
Zerbo A, Delgado RC, González PA. Vulnerability and everyday health risks of urban informal settlements in Sub-Saharan Africa. Glob Health J. 2020;4(2):46-50.
Gupte J, Mitlin D. COVID-19: what is not being addressed. Environ Urb. 2021;33(1):211-28.
Corburn J, Vlahov D, Mberu B, Riley L, Caiaffa WT, Rashid SF, et al. Slum health: Arresting COVID-19 and improving well-being in urban informal settlements. J Urban Health. 2021;98(2):309-10.
Otieno PO, Wambiya EOA, Mohamed SM, Mutua MK, Kibe PM, Mwangi B, et al. Access to primary healthcare services and associated factors in urban slums in Nairobi-Kenya. BMC Public Health. 2020;20(1).
Satterthwaite D, Sverdlik A, Brown D. Revealing and responding to multiple health risks in informal settlements in Sub-Saharan African Cities. J Urban Health. 2019;96(1):112-22.
Wambiya EOA, Otieno PO, Mutua MK, Donfouet HPP, Mohamed SF. Patterns and predictors of private and public health care utilization among residents of an informal settlement in Nairobi, Kenya: a cross-sectional study. BMC Public Health. 2021;21(1).
Lines K, Makau J. Taking the long view: 20 years of Muungano wa Wanavijiji, the Kenyan federation of slum dwellers. Environ Urb. 2018; 30(2):407-24.
Accountability and Responsiveness in Informal Settlements for Equity (ARISE) Hub. Learning Report. 2024. Available from: https://www.ariseconsortium.org/wp-content/uploads/2024/09/ARISE-learning-report-2024.pdf.
Karuga R, Steege R, Njoroge I, Liani M, Wiltgen Georgi N, Otiso L, et al. Leaving No One Behind: A photovoice case study on vulnerability and wellbeing of children heading households in two informal settlements in Nairobi. Soc Sci. 2022; 11(7).
Accountability and Responsiveness in Informal Settlements for Equity (ARISE) Hub. Making every household count through a community driven process. 2021. Available from: https://www.ariseconsortium.org/making-every-household-count-through-a-community-driven-process/
Horn P. Enabling participatory planning to be scaled in exclusionary urban political environments: lessons from the Mukuru Special Planning Area in Nairobi. Environ Urban. 2021;33(2):519-38.
Muungano Wa Wanavajiji. Mathare settlements profiling data findings - Making the invisible visible. Muungano Wa Wanavajiji Website. 2022. Available from: https://www.muungano.net/publicationslibrary/2022/11/28/mathare-settlements-profiling-data-findings-making-the-invisible-visible
Omondi J, Waithaka J. Towards realizing the Mathare Special Planning Area Research Consortium (MSPARC) Agenda. 2021. Available from: https://static1.squarespace.com/static/58d4504db8a79b27eb388c91/t/61d80bd9e9389515c5f9c1e8/1641548762065/Muungano+MSPARC+REPORT+on+enumeration+in+Kiamutisya.pdf
Nobles J, Wheeler J, Dunleavy-Harris K. et al. Ripple effects mapping: capturing the wider impacts of systems change efforts in public health. BMC Med Res Methodol. 2022;22:72.
Mooney R, Dempsey C, Brown BJ, Keating F, Joseph D, Bhui K. Using participatory action research methods to address epistemic injustice within mental health research and the mental health system. Front Public Health. 2023;11.
Aktar B, Alam W, Ali S, Awal A, Bayoh M, Chumo I, et al. How to prevent and address safeguarding concerns in global health research programmes: practice, process and positionality in marginalised spaces. BMJ Glob Health. 2020;5(5):e002253.
Mansaray B, Dean L, Tubb P, Josyula KL, Okoth L, Chumo I, et al. Implications of COVID-19 for safeguarding in international development research: learning, action and reflection from a research hub. BMJ Glob Health. 2022;7(5):e008122.
Otiso L, Steege R, Njoroge I, Okoth L, Tubb P, Nyothach E, et al. Safeguarding in practice: anticipating, minimising and mitigating risk in teenage pregnancy research in urban informal settlements in Nairobi, Kenya. BMJ Glob Health. 2024; 9(2):e013519.
Amendah DD, Buigut S, Mohamed S. Coping strategies among urban poor: Evidence from Nairobi, Kenya. PLoS ONE. 2014;9(1):e83428.
Steege R, Taegtmeyer M, McCollum R, Hawkins K, Ormel H, Kok M, et al. How do gender relations affect the working lives of close to community health service providers? Empirical research, a review and conceptual framework. Soc Sci Med. 2018;209:1-13.
Kok MC, Kane SS, Tulloch O, Ormel H, Theobald S, Dieleman M, et al. How does context influence performance of community health workers in low- and middle-income countries? Evidence from the literature. Health Res Policy Syst. 2015;13(1):13.
Kok MC, Ormel H, Broerse JEW, Kane S, Namakhoma I, Otiso L, et al. Optimising the benefits of community health workers’ unique position between communities and the health sector: A comparative analysis of factors shaping relationships in four countries. Glob Public Health. 2017;12(11):1404-32..
Musoke D, Jonga M, Ndagire GK, Musasizi B, Gidebo A, Tolossa A, et al. Involvement of community health workers in the COVID-19 pandemic response in Uganda: A qualitative study. PLoS Glob Public Health. 2024;4(6):e0003312.
Wahl B, Lehtimaki S, Germann S, Schwalbe N. Expanding the use of community health workers in urban settings: a potential strategy for progress towards universal health coverage. Health Policy Plan. 2020;35(1):91-101.
Njoroge I, Wiltgen Georgi N, Okoth et al. You are just like them: The paradoxical position of Nairobi's community health promoters, a photovoice study. Soc Sci Med - Health Syst.2025; 4:100068.
Muriuki ZK, Kei R, Muchiri JM. Disaster mitigation measures as strategies of disaster risk preparedness in informal settlements of Nyeri Town, Nyeri County, Kenya. Eur J Health Sci. 2022;7(6):45-59.
Ngau PM, Boit SJ. Community fire response in Nairobi’s informal settlements. Environ Urban. 2020;32(2):615-30.
Winter SC, Aguilar NJ, Obara LM, Johnson L. “Next, it will be you”: Women’s fear of victimization and precautionary safety behaviors in informal settlement communities in Nairobi, Kenya. Violence Against Women. 2021; 28(12-13):2966-2991.
Jones P, Kimari W. Security beyond the men: Women and their everyday security apparatus in Mathare, Nairobi. Urban Stud. 2019;56(9):1835-49.
Meth P. Informal housing, gender, crime and violence: The role of design in urban South Africa. Br J Criminol. 2016; 57(2): 402–421.
Adzande PM, Paula; Commins, Stephen. Safety and security: Domain report. ACRC Working Paper 2024-07, African Cities Research Consortium, The University of Manchester, 2024. Available at: https://www.african-cities.org/publications/working-paper-7/
Mutahi P and Wanjiru KJ. Police brutality and solidarity during the COVID-19 pandemic in Mathare. 2020, Available at: https://shs.hal.science/halshs-03078529/document
Ouma S, Wairutu J, Omondi J. Youth and community health volunteers in informal settlements demand safe spaces and inclusion. Cities Health. 2023;7(6):935-9.
Laldaparsad S, Coetzee S, Davis N. A holistic categorization of address purposes as an analytical entry point to finding solutions for addressing in South Africa. S Afr J Geomat. 2024;13(2).
Universal Postal Union. Addressing the world - An address for everyone. Bern, Switzerland: Universal Postal Union; 2012.
Kamalipour H, Dovey K. Mapping the visibility of informal settlements. Habitat Int. 2019;85:63-75.
Watson V. Seeing from the South: Refocusing urban planning on the globe’s central urban issues. Urban Stud. 2009;46(11):2259-75.
Corburn J, Njoroge P, Weru J, Musya M. Urban climate justice, human health, and citizen science in Nairobi’s informal settlements. Urban Sci. 2022;6(2):36.
Patel S, Baptist C, D’Cruz C. Knowledge is power – informal communities assert their right to the city through SDI and community-led enumerations. Environ Urban. 2012;24(1):13-26.
Ouma S. Participation as ‘city-making’: a critical assessment of participatory planning in the Mukuru Special Planning Area in Nairobi, Kenya. Environ Urban. 2023;35(2):470-89.
Makau J, Dobson S, Samia E. The five-city enumeration: the role of participatory enumerations in developing community capacity and partnerships with government in Uganda. Environ Urban. 2012;24(1):31-46.
Satterthwaite D, Archer D, Colenbrander S, Dodman D, Hardoy J, Mitlin D, et al. Building resilience to climate change in informal settlements. One Earth. 2020;2(2):143-56.
Bandauko E, Kutor SK, Annan-Aggrey E, Arku G. ‘They say these are places for criminals, but this is our home’: internalising and countering discourses of territorial stigmatisation in Harare’s informal settlements. Int Devel Planning Rev. 2022;44(2):217-39.
Ozano K, Alam W, Aktar B, Okoth L, Chumo I, Quach JA, et al. Seven core competencies and conditions for equitable partnerships and power sharing in community-based participatory research. BMJ Glob Health. 2024;9(11):e015497.