In the world of flying toilets - Perceived health benefits of improved environment. A case study of Nairobi slums.

Abstract: This study explores how community members in Nairobi slums perceive the health benefits of improvements of the physical environment with focus on water and sanitation, how it can be obtained, further sustained and how the community members can be involved. Location and socioeconomic status variations were also explored. A comparative, qualitative case study was done inspired by the theories of social determinants of health and capability approach. Seeing the analysis according to the health belief model, the threats and the barriers were dominating. Benefits of various kinds, especially less infectious diseases, self-esteem and job opportunities enhancing social inclusion were perceived, however the self-efficacy and cues to action were limited and actions mostly relied on external support and influences. Sustainability was seen to be mainly threatened by poverty however income generating activities were seen as possible solutions. Few variations in perception in relation to socioeconomic status were observed. The outcome showed the inter linkages between the social determinants of health and people’s perception of what they are capable of at an individual as well as at a community level and further that initiatives aiming to improve the physical environment in the slums should involve the slum dwellers.