Comitato Collaborazione Medica INTERNATIONAL DEVELOPMENT ORGANIZATION |
Horn
of Africa Regional Office Tel: (+254) 02 4448750 |
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CCM-UNICEF |
KENYA |
PROJECT
PROPOSAL |
MARCH 2006 – FEBRUARY 2008 |
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Organizational Background CCM “Comitato Collaborazione Medica” (Medical Collaboration Committee) is a non-governmental organization founded in Turin in 1968 whose guiding principles are the values of solidarity and equity, acceptance of the different cultures, enhancement of human resources and promotion of self development. Its main activities are in the field of health, but it is also active in other fields, such as education, livestock development and food security. At present CCM is working in South Sudan, Kenya, Uganda, Burundi, Ethiopia, Somalia and Guatemala. Created in 1968, CCM received accreditation from the Italian Ministry of Foreign Affairs in 1972; signed a Framework Partnership Contract with ECHO in 1994 and 1999; is a member of the OLS/UNICEF since 1992. In 2003, CCM subscribed to the code of conduct of the Non-Governmental Organization, People in Aid, and is in the process of restructuring the organization and its operations to conform to this code of conduct. Its main activities are in the health sector although it also has activities in the water and education sectors. At present, the organization is running the following projects in its areas of operation: · Support to Rumbek Regional Hospital, South Sudan, a three year (2004-2006)project funded by the Italian Ministry of Foreign Affairs; · TB and leprosy control program in Billing, South Sudan, a one year project supported by WHO; · IMCI and Guinea Worm eradication program in Adior, Yirol county, Lakes Region, a one year project co-funded by WHO and Carter Centre Global 2000; · IMCI and Guinea Worm eradication program in Bunagok, Awerial county, Lakes Region, a one year project co-funded by WHO and Carter Centre Global 2000; · Surgery in remote areas of Bahr el Ghazal, a three year (2003-2005) project funded by the Italian Ministry of Foreign Affairs. · Community Centre project in Bunagok, Awerial County, South Sudan, a six months project funded by USAID through UNICEF in the frame of the Quick Start Community Improvement Programme. A community development program supporting WES services, primary education and primary health care in Bunagok, Lakes Region · TB Control programme in Awerial, Yirol, Gongrial and Jonglei Counties, South Sudan funded by the GFATM · TB Control programme in North, Central and South Somalia, funded by GFATM · Support to the RHB in the Development of Health Services in Gode Zone, Ethiopia funded by the Austrian Government · Support to the RHB in the Development of Health Services in Liben Zone, Ethiopia funded by the Austrian Government · Technical support for outreach teams advocating against Harmful Traditional Practices (FGM) in Gode Zone, Ethiopia funded by the Austrian government · Strengthening of Surgical Services at Mbagathi Hospital, Nairobi, Kenya funded by the Italian Ministry of Foreign Affairs · Increased access to health services in Sololo Division, Moyale, Kenya Interventions have a special emphasis on capacity building (both through formal training at accredited schools and on the job training) and are designed and conducted in close conjunction with local authorities and the institutional counterparts in order to enhance the sense of national ownership of the programs. CCM has a highly decentralized structure that grants its regional offices autonomy and flexibility in the design and implementation of the programmes. CCM Regional Office for South Sudan, Kenya and Somalia is located in Nairobi and is headed by a Regional Representative, supported by a Medical Coordinator, a Regional Administrator, a Programme evelopment Officer, a Logistics Coordinator and support staff. These professionals coordinate a number of support staffs in the offices as well as the staffs in the field. Problem Statement and Rationale for the Project Female Genital Mutilation (FGM) also known as Female Circumcision (FC) is a deeply entrenched practice in most African communities. It constitutes all procedures that involve the partial or total removal of the external female genitalia or other injury to the female genital organ for cultural or any other non-therapeutic reasons. The origin of FGM is not known but the practice has been perpetuated from one generation to another. Some people believe that the practice originated in ancient Egypt while others believe that it started during the slave trade. Female genital mutilation is practiced by followers of a number of different religions, including Muslims and Christians (Catholics, Protestants and Copts), by animists, and also by non-believers in the countries concerned. The practice is deeply embedded in local traditional belief systems. Irrespective of where and when FGM was initiated, it is clear that the people who practice FGM share a similar mental framework that presents compelling reasons why the clitoris and other external genitalia should be removed. The clitoris and external genitalia are believed to be ugly and dirty, and if not excised can grow to unsightly proportions. The clitoris is also believed to prevent women from reaching maturity and having the right to identify with a person’s age group, the ancestors and the human race. According to numerous myths associated with this set of beliefs, the external genitalia have the power to make a birth attendant blind; cause infants to become abnormal, insane or die; or cause husbands and fathers to die. In addition, they are purported to make women spiritually unclean. Their removal is thus perceived to be required by religion. Rationale/justification for this practice varies from community to community with the most common ones being protection of girls, to guarantee their acceptance, respect and marriage ability within the community, ensure cleanliness, and prevent promiscuity and excessive clitoral growth. Female genital mutilation causes grave damage to girls and women and frequently results in short and long-term health consequences. The effects on health depend on the extent of cutting, the skill of the operator, the cleanliness of the tools and the environment, and the physical condition of the girl or woman concerned. Girls and women undergoing the more severe forms of mutilation are particularly likely to suffer serious and long-lasting complications. Many women appear to be unaware of the relation between female genital mutilation and its health consequences; in particular the complications affecting sexual intercourse and childbirth which occur many years after mutilation has taken place. Moreover, in many cases, women have been conditioned socially to accept the practice and the pain it causes. However, traditional practitioners are often aware of the health problems of female genital mutilation and may perpetuate various myths to make women believe that these are normal. In Kenya, FGM is practiced in more than 50% of Kenya’s districts. Efforts to eradicate the practice can be traced as far back as the pre-independent Kenya and anti-FGM activities were mainly in the Central Province pioneered by the colonial government and Christian missionaries. In the past decade however, campaigns against FGM have intensified and Kenya’s efforts include the adoption of various plans of action that view FGM as a violation of human rights against women and girls and the ratification of the various conventions on the rights of women and children with the most recent one being the Maputo protocol. There has also been intensified lobbying by Non-Governmental Organization for a legislation outlawing FGM in all age brackets. Despite efforts by Non-Governmental Organization in eradicating the FGM in other parts of the country, the practice is widespread amongst communities such as the Somali, Borans, Rendille, Samburu, Maasai and Kisii. Moyale district is geographically located in Northern Kenya though administratively it is in Eastern Province. The district is divided administratively into four divisions i.e. Central, Obbu, Uran and Golbo divisions. Moyale borders Ethiopia to the North, Marsabit district to the South west, Wajir district to the South east and Isiolo to the South. The district has a population of 58, 571 people. The community is predominantly Boran although there are Garres, Ajurans, Gabras and Sakuye living within the district. Female Genital Mutilation is a universal practice among the communities living in Moyale. A study carried out in the area revealed that the prevalence of the practice among women and girls is 96.8%. All three types of circumcision i.e. Clitoridectomy, excision and infibulation are practiced within the district. Excision is the most predominant in the community while infibulation is practice by the Garre and Ajuran. Qualitative data from the study sheds light on the social significance of the practice and reason for its continuation. FGM is considered as an important tradition and significant rite of passage into adulthood, providing girls with recognition from their peers and increasing girls’ chances of marriage. The practice is also perceived as a means of preventing promiscuity and is believed to promote easy childbirth. There are many general community enforcement mechanisms that allow the practice to continue including the multitude of myths regarding FGM. Women who do not circumcise their daughters are viewed by some as irresponsible and imitators of western culture. Girls in the community are normally circumcised between the ages of 6-15 years. The study revealed that 81% of women had been circumcised between the ages of 10-15 years. The role of circumcising girls has been assigned to traditional circumcisers and traditional birth attendants. While FGM eradication efforts have yielded positive results in other parts of the country, in this area girls continue to be subjected to the practice due to ignorance and lack of information about the harmful effects of this practice which can be attributed to lack of advocacy against the practice by actors in the anti-FGM campaign. Moyale district like other parts of the Northern region of Kenya has had its shares of natural calamities (droughts) as well as insecurity problems characterized by banditry and frequent attacks by the Oromo Liberation Front as well as the Ethiopian military from across the Ethiopian border. This has led to the diversion of government development funds for the district to security enforcement in the area and subsequently wards off development actors and donors from the area for the reason of insecurity. For the few who operate in the area, their main focus seems to be relief. This explains the lack of infrastructure, development and subsequently the marginalization of the area. As a result of these factors, efforts of FGM eradication have not been taken up in this area. Project Framework Overall Goal To accelerate the reduction of female genital mutilation in order to improve the health quality of life and well being of women, girls and families in the district. Objectives To increase the proportion
of the community supporting the elimination of female genital mutilation
through positive changes in attitudes, beliefs, behaviour and practices.
Approach FGM is a very sensitive topic amongst practicing communities most of whom are nomadic, have little or no formal educational background therefore unaware of their basic entitlements and have problems in relation to access to and affordability of basic social services that tackling it on its own would not yield the desired results. The approach to be adopted for this project is that of empowering the community with knowledge not only on FGM but general health and life skills in order to empower these communities particularly the women in making informed choices/decisions on pertinent issues affecting their lives. This will be integrated within existing outreach projects on health, veterinary and education in the district in order to combine community education with service delivery. Description of Activities The project will be implemented through the advocacy, outreach, capacity building and empowerment strategies. Activities for the project are described under each strategy below: Advocacy: Disaggregated sensitization
workshops for elders and religious leaders on FGM at the divisional and
district level to solicit support among the community leadership leading
to a public declaration against the practice. Outreach Awareness for the nomadic
pastoralists through human and animal health outreach programmes at crucial
watering points on specific days and inter-sectoral collaboration. CCM
will conduct awareness sessions alongside its mobile clinic services among
the pastoralists and in areas where CCM does not provide mobile clinical
service, CCM collaborate with other organizations particularly those involved
in veterinary health in carrying out outreach awareness. Functional capacity building for health and other key institutions in handling FGM related complications and supporting women and girls affected by FGM. This will involve the pre-testing of the training modules developed by Population Council and adopting it to the local needs if not addressed by the initial module. The management of FGM related complications training will target medical personnel (nurses, clinical officers and TBAs) at all levels of the health care provision and psycho-social support training for health staff and teachers. Consultants will be hired to develop the training modules as well as provide obstetric and gynaecological training in relation to FGM and psycho-social training respectively. The project will aim at training 20 health workers from the category of nurses and clinical officers especially those working at the dispensary level and at least 60 TBAs. The training of the TBAs will be carried out within the primary health care program run by CCM and will form part of the organization’s in kind contribution towards this program. The nurses and clinical officers will also be trained on psycho-social support as well as 20 teachers drawn from the various primary and secondary schools within the district. Follow-up on the impact of these training will be done through constant monitoring and supervision of the trainees by the CCM field coordinator and through the reports received from the health facilities where the staff underwent the training. The trainees will then receive a refresher course after the first year of the project. Empowerment of women Support to the economic activities
of women groups through funding and training to enable women to be independent
decision makers. To achieve this, a market analysis will be carried out
to establish the most viable economic activities for women in the area
hence determining the type of training and support to be provided to women
through the various women groups in the area. The training and support
will also be extended to the traditional circumciser as a means of discouraging
them from engaging in the practice through provision of an alternative
source of income. Expected Outputs Increased proportion of community
based anti-FGM advocacy Focus Population The beneficiaries of the project will be the communities in Moyale district of whose majority are Borana and the project will target parents, guardians, the Youth (male and female), religious leaders, community leaders, ethnic leaders, social workers, children’s officer, school heads, chiefs, health workers, TBAs/CHWs, Legislators and Civic leaders. Reporting, Monitoring and Evaluation Monthly progress reports will be submitted by the field to Nairobi office. CCM will submit quarterly progress reports to UNICEF-KCO. Monitoring of the project will be a continuous process with frequent monitoring visits conducted by the Nairobi Office. CCM will conduct two evaluations during the project period; one at the end of the first year and the second one towards the end of the project.
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