As you walk through Kibera (taking note of friendly warnings to watch for thieves and for the flying toilets -- plastic bags that double for more sophisticated facilities) it does not take long to grasp how much people want health care. Located in central Nairobi in Kenya, Kibera is said to be Africa's largest contiguous slum. But, though many families have been there for generations, there are no government-run clinics (or schools, for that matter) in this "irregular" settlement. The crude signs everywhere that advertise medicines, male circumcisions, tooth extractions, pretty much any kind of care, are clues to how people deal with sickness and pain: a blend of hearty entrepreneurial energy and altruism.
One of the many facilities run by a wide gamut of religiously linked organizations is the modest Chemi Chemi Ya Uzima clinic, not far from an entrance to Kibera. Run by a Nairobi Baptist church, the name means "spring of life." It caters to the community's many needs, including one that some might find surprising in a faith-run facility: family planning. Chemi Chemi reflects the vision of a Nairobi congregation which, came together over a decade ago to share God's love (that's the way they explain their motivation) through service.
The early plans were idealistic and the founders' vision broad: they wanted to serve "anyone and everyone" in a community (and country) where diversity is both a source of pride and conflict. The demands of diversity gave the founders a first lesson. Seeking to understand why construction materials vanished each day, they met with community leaders. People (mostly Muslims) suspected that the newcomers had come to convert them. The experience drove home the lesson that listening to what people wanted and being sensitive to their needs is a vital part of service. The clinic's founders have not forgotten that lesson.
When I visited I wanted to understand how a thoroughly faith-inspired clinic saw and dealt with family planning. The answers surprised me. First, the clinic staff was completely matter-of-fact about the topic. To them, providing information and contraceptives to men and women was obviously vitally important: no qualms or debates about it. Their ethic is to care for people and that care includes family planning. Another surprise was how family planning is an integral part of the services the clinic provides. It was considered to be in the same category as antibiotics, vaccinations or weighing babies: part and parcel of what basic health care entails.
There are complications. Women at the end of their tether making a living and caring already for several children are eager to avoid or delay another pregnancy. But their husbands and mothers-in-law often see the matter differently; whether it is family or male pride or blindness to the amount of care a child needs, they sometimes assume that a woman will keep having children. Having at least one son is vital for cultural reasons. The clinic cares for orphans who have lost their parents to HIV and AIDS, and one of their central goals is to avoid new infections. The clinic's method is a blend of working with families as an intrinsic component of the broad services they provide, but they cater to women and men's distinctive needs. For example, men who want protection against HIV may be "shy" and hesitant to seek help due to societal norms, so condoms need to be kept where they can collect them discreetly.
The clinic's family orientation is fundamental. They seek to help the whole human being and the whole family. They support children with a range of special needs, visit people who are bedridden, and advise on the importance of clean water and sanitation. Family planning is just a basic part of that orientation and care.
On February 10, the World Faiths Development Dialogue (WFDD -- which I lead) and the Universal Access Project of the United Nations Foundation will launch a report that describes the approaches of many faith-linked clinics and facilities that, like Chemi Chemi, are a vital aspect of health care systems that serve the poor. The report highlights a remarkable diversity in what the facilities look like and the many demands on them, especially in terms of finances and administrative capacity. What every program we looked at had in common was a shared concern to provide decent care to those in need and a keen awareness of the ethical and practical choices that this care requires.
Amidst this diversity, Catholic, Protestant, Muslim shared the pragmatic, matter-of-fact approach towards family planning that I saw at Chemi Chemi, and other providers highlighted in our report. Helping families to space children so they can care for their families is an essential part of decent care. There are concerns about how some forms of contraception fit with theological beliefs. Many (not all) faith-linked caregivers view abortion with caution or oppose it outright, but they are close enough to those who choose it to understand the desperation that such a choice can entail.
The bottom line? Faith-linked providers are vital to the global challenge of ensuring access to family planning. The many providers tend to be driven by concern for their clients more than by theology and they are keenly aware that family planning is essential for building strong families. That's as true in Kibera as it is in Washington DC.
