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In Kenya, gaps exist in health service provision to slum residents, especially service availability and access to quality care. There is also little information on the health status of people living in slums other than in Nairobi. The purpose of this paper is to generate evidence for use in designing interventions to improve health services in four mid-sized slums in Embu, Nyeri and Thika, Kenya.

A cross-sectional survey of clients receiving services in health facilities was conducted in the targeted slums. Data were collected through face-to-face interviews. Factor scores were generated using the Rasch model; simple and multivariate logistic regression analyses were done using the R statistical software.

Overall, 81 per cent of the 203 participants reported being satisfied with health services. Most clients (89 per cent) reported that health facility staff greeted them warmly; 82 per cent said their consultation was private. The facility type, waiting time and client experience with service providers determined their satisfaction (p < 0.05).

Healthcare managers can improve client satisfaction levels by understanding the client flow in their facilities and addressing causes of client dissatisfaction, such as long waiting times, while at the same time promoting facilitating factors.

The authors use latent variable modelling to compute client satisfaction scores, which were dichotomised into two categories and fitted into a logistic regression model to identify factors that influence client satisfaction. Health facility clients in the four slums are satisfied with services and have confidence the providers will serve them in a friendly and professional manner that promotes respect and quality care. The paper recommend healthcare managers in similar settings carry out client flow analysis and institute remedial measures to address long waiting times. Qualitative studies are recommended to determine the reasons behind the high satisfaction levels reported in this study.

If ever Africa had disappeared, it has now reappeared on the maps of investors seeking for land and resources. The entire continent seems to have become attractive for international financial institutions, which intensify their recommendations to single national Governments in order for them to further remove obstacles and make Africa an “ever better place to do business”.

Rwanda represents an emblematic example of the rapidity and size of transformations Africa is faced with, which touch every sector, from the land ownership model to the modes of land use, from the distribution of population, to the construction of infrastructure.

It is a fertile country, with a good water supply and two crop seasons, and is almost entirely cultivated. The majority of the inhabitants work the land, and subside thanks to agriculture. Today, however, the Government's goal, synthetically expressed in the slogan that defines the future of Rwanda as Africa's Singapore (Vesperini, 2010), is the modernization of agriculture, and the reduction of its weight in favour of a service economy. The most visible effects of this approach are the expulsion from the countryside of a huge number of families which lose any type of sustainment, and the grouping of many small plots in large territorial extensions which are often given for long term use to multinational agribusiness corporations. The transformation of agriculture is accompanied by the redistribution of population, traditionally settled in scattered patterns across the whole country. The massive migration from the countryside is explicitly sought by Government, whose target is to reach, by 2020, a 35% urbanization rate up from today's 18%.

The three issues, total and unconditional opening to foreign investment, population resettlement and transformation of the agricultural activities, which are the pillars of the development programs initiated by Government and international advisors, are producing dramatic changes on the physical and built environment, and affect the living conditions of the weakest groups (White, Borras, Hall, Scoones, Walford, 2012).

The paper proposes a reflection on themes which have general relevance, but which also need to be locally grounded. Of particular importance are urbanization, the relationship between towns and countryside, and the relationship between social and economic structure and territorial planning.

In 2012 the author took part as consultant to the drafting of the Urbanization sector strategic plan 2012-2017. The views expressed here are personal and do not in any way represent the Government or Institutions’ point of view.

To analyze the impact of policy on people's identities, and the conflicts which can result from this.

The case of the Rwanda genocide is used to examine identity disturbances related to policies.

Identity adjustments generated by policies can have devastating effects such as genocide. This raises the issue of national decision makers' responsibilities as well as those of the international institutions advocating and enforcing such policies.

This study implies that we need to consider the impacts of policies on people's identities and to extend such empirical research.

The issue of institutions' responsibilities must be discussed, for both national and international institutions; and a precautionary principle in decision making must be set for expert advisors.

The paper addresses the links between economic policies and their effects on individual identity, an area which has not yet been examined in economic studies.