1. BACKGROUND INFORMATION
1.1. INTRODUCTION
Pastoralist
foundation for life mobile integrated Health Care Services Project in the North
of Kenya, by providing basic Health Care and Social Services to the Pastoralist
groups inhabiting Sololo District. The
a)
The
government contribution to the Health Sector shows that in real terms the Per
capital expenditure has declined from $ 9.5 to $ 83.4. Poverty is widespread and it is estimated
that 30% of the absolute poor live in rural areas.
b) SOLOLO DISTRICT
Sololo
District is a newly created District curved out of Moyale District in
2009. It is located in
Livestock
rearing is the most important economic activity of the population with a cattle
population of 179,889, camel population of 34,689 and sheep and goat population
of 63,808 (Source: draft report on ASAL Natural Resources and awareness, 2005)
The major
problems in the District are droughts, insecurity, banditry, livestock raids
and intertribal conflicts. The main
health problems in the district are Malaria, HIV/AIDS, Tuberculosis, diarrhea, pneumonia
and malnutrition.
TABLE
1: POPULATION AND HOUSEHOLDS CENSUS FOR SOLOLO DISTRICT
|
No. |
Centre |
Total population |
Households |
|
1 |
Dambala
Fachana |
1,278 |
320 |
|
2 |
Garba |
750 |
183 |
|
3 |
Anona |
1,311 |
261 |
|
4 |
Mado
Adhi |
934 |
236 |
|
5 |
Sololo
township |
5,093 |
1,080 |
|
6 |
Waye
Godha |
556 |
72 |
|
7 |
Amballo |
321 |
90 |
|
8 |
Sololo
Makutano |
1,233 |
311 |
|
9 |
Golole |
1,009 |
274 |
|
10 |
Karbaruri |
693 |
177 |
|
11 |
Banale |
85 |
22 |
|
12 |
Rawana |
312 |
69 |
|
13 |
Uran
Lataka |
978 |
267 |
|
14 |
Uran |
1,255 |
333 |
|
15 |
Walda |
325 |
94 |
|
TOTAL |
16,133 |
3,789 |
|
Source:
Door to door HIV testing and counseling strategy will
utilize this data in planning the targets.
This data only reflect the population in satellite centres, but the
population in remote interior of the District is not included. The project also aims at reaching this
population in the interior.
c) PASTORALIST FOUNDATION
FOR LIFE
Pastoralist Foundation for life is a community based
organization founded by three health professionals in Sololo District. The office of the CBO is located at Sololo
town. The Primary aim of the CBO is to
facilitate basic social and health Services access to the Pastoralist groups in
Sololo District.
Pastoralist Foundation for Life is a non profit
making organization. Its main purpose is
facilitation of service delivery to the pastoralists in the remote interior of
the District through mobilization of resources eg. money, materials, man power
etc from Donor partners. The vision,
mission and core values of the organization are as follows:-
VISION
To promote human development and social justice in
delivery of basic services to the marginalized pastoralists communities in
Sololo District in
To facilitate the provision of quality Health
promotion and basic social services to the marginalized pastoralists
communities in Sololo District in
CORE VALUES
1.
Transparency
and accountability
2.
Team
work
3.
Collaborating
and networking with all stakeholders
4.
Community
empowerment through education, Health and capacity building
5.
Commitment
and Handwork
6.
Efficient
Management of resources for the welfare of the people
7.
Discouraging
dependency and building the spirit of self reliant and self determination
1.2. HEALTH AND DEVELOPMENT ANALYSIS
Pastoralist society in Kenya are people who are caught in a
never ending struggle for survival with unsafe water, too little food, little
education and no voice or power in national decision making. They are people who are denied
liberation. This holds them back from a full human life, which is about
transforming the society and building a new future with a new society.
A need
assessment survey carried out by Pastoralist foundation for life on the health
and development on pastoralism in Sololo District focused on;-
@ Pastoralist food security system and
development needs
@ Reproductive health needs in pastoralism.
@ Pastoralist water system and development
needs.
@ Interaction between HIV/AIDS and
pastoralist food security system
a) PASTORALIST FOOD SECURITY
SYSTEM AND DEVELOPMENT
NEEDS
Livestock
production system forms the backbone of pastoralist food security system.
Diseases, drought and cattle rustling seriously affect livestock production system.
Livestock loses due to drought creates households economic damage and poverty,
facilitating pastoralist drop out from pastoralist lifestyle to street dwellers
in satellite centres and major towns in
Drought
crisis resulting from rainfall shortages breakdown families and triggers pastoralist
labour mobility to major towns to search for jobs as a drought coping strategy
and self-restocking mechanism. In the process struggling to meet the basic
needs in major towns, the pastoralist acquires sexually transmitted infections
and HIV / AIDS. They fallback after the drought is over, and facilitate the
transmission of HIV/AIDS in the rangelands.
Fragile
security situation leading to proliferation of small firearms used for cattle
rustling to facilitate self-restocking after drought or disease outbreak
causing massive livestock loses and households poverty. Limited markets for
livestock and their products makes pastoralist economic base fragile and
unstable but Pastoralist have limited knowledge on utilization of natural
resources potentials
e.g .
land, water sources, wild life for eco-tourism ,sand, gravels vegetation for
commercial purposes eg timbers. These resources are exploited by few rich
people who claim to be assisting the pastoralist to solve their problems.
High
pastoralist rural-urban migration during drought, cattle rustling and tribal conflict
creating poverty and development of slums in satellite centres. Street children
are becoming major problems in most pastoralist shopping centres. This is also
accompanied by young girls prostitution to search for basic needs, facilitating
transmission of STI and HIV/AIDS. Households food insecurity regardless of
seasons, facilitating brewing of changaa in villages. This builds up a culture
of alcoholism in villages and waste of economic resource due to negligence of
livestock rearing. Heavy relief food delivery during drought spells with
prolong distribution of relief food create dependency syndrome, in society
reducing the spirit of self-reliance and self-determination.
Childhood
malnutrition is prevalent among the pastoralist during drought and famine, when
there is serious shortage of animal milk. Lack of essential nutrients leads to
immunodeficiency of the general population during drought and famine,
triggering out break of pneumonia, diarrhea and communicable diseases. Lack of supplementing
facilities to pastoral system e.g slaughter houses, meat and milk processing
plants. Little awareness on basic principles of pastoral land use system by
decision makers. Lack of pastoralist voice in decision making and policy
formulation. Agro-pastoralism is possible in some areas, but majority of the
pastoralist do not practice crop farming because they live in arid and semi
arid areas. Pastoralist purchase food stuffs in shopping centres during food
shortages .i.e drought and famine. These food stuffs are sold at high prices
and pastoralist are exploited in the process.
b)
REPRODUCTIVE HEALTH NEEDS IN PASTORALISM.
Male domination in reproductive health
decision making is central in pastoralism. Husband decides for facility
delivery and antenatal attendance. Male also decides how family resources are
used for reproductive health needs of the mother and the family. Home
deliveries are most prevalent than health facility deliveries among the
pastoralists. These deliveries are conducted by unskilled traditional birth
attendants under unhygienic condition, predisposing to puerperal and neonatal
sepsis. Limited accessibility of family planning services in pastoralist
community, leads to large family sizes. High risk pregnancies are also
prevalent due to lack of family planning information and services. Early child
marriage. This subject young girls to obstetric complication during deliveries
because their reproductive system is immature to withstand physiological stress
of pregnancy and labour. Obstructed labour becomes prevalent in young women and
vesico-vaginal or recto-vaginal fistulae complication.
Vesico-vaginal
fistula are very distressing experience to young women, and this subject them
to stigma and divorce. Negative social cultural belief of the pastoralist
community on the reproductive health service. Perception of children as sign of
wealth in pastoralist society. Women are seen as producer of children. This
subject them to multiparity and high risk obstetric categories.
High risk obstetric category causes maternal
morbidity and mortality. Lack of ownership of economic resources for women,
hindering the ability to meet cost for reproductive health care services.
Discrimination of girl-child in education with future negative impact in adult
life decision making. Poor health service delivery and system in pastoralist
community , limiting utilization of reproductive health services. Pastoralist
lack knowledge on existence of reproductive health services. Female genital
mutilation practices. This is complicated with haemorrhage, sepsis, scaring ,
obstructed labour and vesico-vaginal fistulas. Migratory lifestyle of the
pastoralist limiting accessibility and deliver of reproductive health services.
Wife inheritance, a risk in transmission of HIV/AIDS in the society. Polygamy,
a risk factor in HIV /AIDS pandemic.
c)
PASTORALIST WATER SYSTEM AND DEVELOPMENT NEEDS
Pastoralist
water system is communally owned. Pastoralist entirely rely on natural water
sources and individually developed by a clan or recognized individual. Water
system is managed by elders who direct the community on usage of water and
protection of water sources from misuse or destruction by other clans or tribes
grazing within the same area. A system of elders schedule the use of water
point during water scarcity. They plan together with those herding livestock
when a particular clan should get water from main community water point. Pastoralist
belief that water is natural and God given resource which should be shared
communally without segregation or exchange of livestock or money. i.e principle
of African socialism. Availability of water is very important in the life of
pastoralist, because it determines their settlement, ceremonial activities and
utilization of pasture from the rangelands. Water points in the pastoralist
lifestyle can be the source of human and animal conflict as well human to human conflict with a loss of life
and property.
Pastoralist
main water points include hand dug wells, earth dams, surface rain off, natural
springs and natural sand dams in river beds. These water sources are subject to
contamination from organic wastes and diseases as the most prevalent morbidity
in pastoralist areas. Pastoralist do not believe on boiling of water, since
they belief that water cannot transmit diseases. Water points in most
pastoralist community occupied areas are not well developed or completely not
developed at all. They are still in their crude form and under utilized for
community development. Water supply is poorly developed in pastoralist occupied
rangelands. Pastoralist are almost always mobile in search for water and
pasture facilitating transmission of communicable diseases in humans and livestock.
Most water
points surrounding areas are overgrazed by livestock resulting in damage of the
eco -system. Human activities e.g settlements are concentrated around permanent
water points, resulting in destruction of the physical environment eg
vegetation and depletion of natural resources. Human consumption of
contaminated water results into their suffering from waterborne diseases eg
cholera, typhoid and amoeba dysentery. Stagnant water from surface runoff, dams
are a favourable media for breeding of mosquitoes larvae. Malaria is usually a
threat to pastoralist who do not know that water is a media for breeding of
mosquito, instead they are happy because of plenty of surface water for their livestock.
During
drought pastoralist move long distance with their livestock to get water for
use. This causes human and livestock stress. Livestock stress during droughts
is more due to search for water and pasture from the distanced rangelands. This
causes animals muscle wasting and poor milk production for human consumption.
Pastoralist
at times conflict with wild animals over water points, and if they are damaged
on the process they are not compensated by the ministry or department concerned
with wildlife, because pastoralist see it as a natural phenomenon. They are not
aware of their rights in relation to conflicts with wildlife.
D. INTERACTION BETWEEN HIV/AIDS AND
PASTORALIST FOOD SECURITY SYSTEM
HIV/AIDS and pastoralist food security system i.e livestock
production system interact and produce Human suffering and mortality in
pastoralism
These interactions include:-
·
Loss
of livestock biomass as a result of drought and diseases.
·
Malnutrition
of all family members.
·
Household
fragmentation due to migration
·
Break
down in pastoralist food security system.
·
Livestock
diseases.
·
Increases
vulnerability to HIV acquisition / transmission through migration/ selling sex for
food.
·
Decrease
pastoralist family ability to purchase food.
·
Increases
care burden within pastoralist family, especially among women and girls.
·
Decrease
pastoralist life expectancy and child survival.
·
Increases
school drop outs especially for the pastoralist girl child.
·
Creates
grand parents/children headed house holds/orphans
·
Diverts
family members from livestock rearing to care for the sick relatives.
·
Loss
of land rights through non-use
·
Strips
pastoralist community assets Human, social, financial and physical.
·
Lead
to loss of appetite and nutrient malabsoption.
·
Exacerbates
existing social inequities, especially those of gender, sexuality and race
·
Pastoralist
household fragmentation and intra family discrimination /exclusion.
·
Declining
livestock rearing can force members of pastoralist households to look for work
in cities and this rural-urban migration can further drive the epidemic.
·
Malnutrition
and HIV/AIDS form a deadly alliance, under nutrition increases the
susceptibility to opportunistic infections and consequently worsen the severity
of HIV associated conditions
·
Increases
incidences of infectious opportunistic infections within families and
pastoralist communities e.g Tuberculosis.
Needs assessment study also tried to find out
marginalized minority groups in pastoralism and
the challenges they face in the community in meeting their health and
development needs. This is shown in
table 1 below:-
TABLE
1: MARGINALISED MINORITY GROUPS IN PASTORALIST AND CHALLENGES THEY FACE MEETING THEIR HEALTH AND
DEVELOPMENT NEEDS
|
No. |
Marginalized minority group |
Health and development challenges faced |
|
1 |
Unmarried
pregnant girls |
·
Communal
rejection and isolation ·
Lack
of resources for meeting basic needs ·
Possibility
of promiscuity ·
No
marriage for life from their community members ·
Victims
of poverty ·
Risk
of acquiring STI/HIV/AIDS ·
Un
met reproductive Health Needs ·
Lack
of money to pay Health Care services ·
Migration
to towns outside their communities |
|
2 |
Divorced women |
·
No
rights to inherit resources and wealth ·
Poverty
·
Social
rejection ·
Possibility
of promiscuity ·
Lack
of money to pay for basic needs ·
Un
met reproductive health needs ·
Migrate
to towns outside their communities ·
Psychosocial
stress in relating to other members of the community ·
Risk
of acquiring STD/HIV/AIDS due to multiple sexual partners ·
Difficulty
in bringing up children as a single parent in resource poor setting |
|
3 |
Disabled
persons |
·
Not
able to meet their basic needs eg blind and physically challenged ·
Lack
of special programmes or services to meet the needs of disabled persons ·
No
representation of the disabled persons in decision making forum in the
district ·
Difficulty
in meeting their health needs eg hygiene accessibility to essential medicines |
|
4 |
Orphans |
·
Lack
of essential basic needs ·
Lack
of parental love and care in up bringing ·
Risk
of acquiring diseases of poor sanitation eg. diarrheal diseases ·
Poor
housing conditions ·
Lack
of basic education ·
Food
shortages, especially during drought and famine, leading to malnutrition. ·
Lack
of psychosocial stimulation as a result of lack of parenting care |
|
5 |
Elderly |
·
Diseases
of aging, rheumatism, joint stiffness, hypertension, heart problems, urine
retention, cancers ·
Malnutrition
due to loss of teeth for chewing hard food stuffs ·
Accidents
from falls due to loss of sight ·
Not
able to meet personal hygiene ·
Poverty ·
Not
able to meet basic needs ·
Not
able to pay for health care bills |
|
6 |
Broken families
due to deaths |
·
Difficulty
in meeting family basic needs eg. Food, health care, education, shelter ·
Poverty
at households, leading to malnutrition ·
Inadequate
parental love and care fro the children ·
Psychological
trauma of the family members |
|
7 |
People living
with HIV/AIDS |
·
Risk
of frequent attack of opportunistic infections ·
Lack
of adequate nutrition during drought and famine to replace worn out tissues ·
Risk
of contracting communicable diseases eg. Tuberculosis and other co-infections
eg. Malaria ·
Periodic
shortages of ARV’s and opportunistic diseases medications ·
Community
discrimination and stigmatization ·
Loss
of jobs for the employed resulting in poverty ·
Family
finances directed to pay medical bills instead of using for family
development ·
Self
denial of being infected by HIV/AIDS, leading to delay in seeking for
treatment and this drive the epidemic in the community |
|
8 |
Female headed
families |
·
Due
to lack of wealth inheritance for women, poverty of households results, this
is associated with diseases of poverty eg. Tuberculosis, malnutrition ·
Poor
housing with transmission of air borne diseases ·
Lack
of essential basic needs eg. Food, water, health care and shelter ·
Family
unit become relief dependent ·
Lack
of basic education for the siblings ·
No
voice in decision making in the community ·
At
risk of STI/HIV/AIDS as a result of multiple sexual partners |
|
9 |
Pregnant and
lactating mothers |
·
Anaemia
resulting from iron and folic deficiency, threatening the life of the mother
and fetus ·
At
risk of pregnancy and delivery related complications eg APH, PPH and Sepsis ·
Poor
transportation system in pastoral areas to facilitate referrals in cases of
emergencies ·
Material
malnutrition in times of household food deficits eg. in drought and famine,
leading to fetal intrauterine malnutrition ·
Malaria
in pregnancy threatening maternal and fetal well being ·
At
risk of transmitting HIV/AIDS to new born infants during pregnancy and
breastfeeding ·
Lack
of financial resources to meet health needs ·
Poverty
in pastoralism limiting accessibility to quality health care services ·
Reduced
immunity in pregnancy predisposing to communicable diseases eg. TB, Malaria ·
Increased
physiological demands in pregnancy and lactation, causing nutritional
deficiency disorders |
|
10 |
Children under
5 years |
·
Biological
pathogens and their vectors/reservoirs eg micro-organisms in Human excreta,
disease vector eg. Mosquitoes, houseflies, rats and air borne pathogens. ·
Inadequate
quantity of natural resources eg. Food, water, fuel ·
Physical
hazards – within the house eg. Domestic injuries and outside eg flooding ·
Poor
services and security ·
Poor
immunization services |
Source:
The needs for
assessment base line survey also revealed disease priorities by communities visited as shown in the table 2
below:-
Table 2: The most common diseases by community
priorities
|
Community |
Community disease priorities |
|
1. Waye Godha |
|
|
2.Mado Adhi. |
|
|
3.Dadach
Elele. |
|
|
4. Rawana |
|
Source:
Malaria
and diarrhoea are the two top causes of morbidity as ranked by the communities.
These diseases are environmental and sanitation-related morbidities. Endemic
diseases in the general population assessment was also done and the community
prioritized the following diseases:-
·
Anaemia.
·
Tuberculosis.
·
Malaria.
·
Sexually
transmitted infections[STI].
·
Skin
infections.
·
Eye
infections.
·
HIV/AIDS.
·
Diarrhoea.
Malaria,
HIV/AIDS and Tuberculosis are endemic diseases in the communities visited. These are global target diseases, because of
their morbidity and mortality burdens to the poor developing countries
communities. Facility –based health care services are the services available to
the community, but community-based services are non -existence.
1.3
THE NATIONAL HEALTH DOCUMENTS
These
documents should be used as technical reference documents by the programme
staff, and can be used in community based trainings. These documents are:-
·
National
guidelines for prevention of mother to child transmission of HIV/AIDS
(P.M.T.C.T.).
·
National
Health sector strategic plan II,2003-2010.
·
National
AIDS strategic plan,2005-2010.
·
National
guidelines for diagnosis treatment, and prevention of malaria.
·
National
guidelines for quality obstetrics and perinatal care.
·
National
guidelines for HIV testing and counseling in
·
National
Tuberculosis and HIV collaborative activities guidelines.
·
National
guidelines on integrated management of childhood illnesses ( I.M.C.I.).
·
WHO
guidelines on the use of insecticide-treated mosquito nets for the prevention
and control of malaria in
The above
documents were referenced during the development of the project proposal, and
they form key component in directing project implementation.
A) NATIONAL GUIDELINES FOR PREVENTION OF
MOTHER TO CHILD TRANSMISSION OF HIV/AIDS (PMTCT)
HIV
infection in infants are most often the result of mother- to- child
transmission during pregnancy, labour delivery and breastfeeding. Comprehensive
prevention of mother-to-child transmission ( PMTCT) programmes, integrated into
maternal- child health programmes, can significantly reduce the number of
infants who are HIV infected and promote better health to mothers and
families. Implementing PMTCT programmes
is a key part of the government strategy to reduce mother-to child transmission
of HIV/AIDS.
B). NATIONAL HEALTH SECTOR STRATEGIC (
2005-2010.)
The
national health sector strategic plan II preparation mainly borrowed from the
national health policy framework of 1994. The key strategy for service delivery
will be decentralization of health services to the districts where the
implementation of the essential health packages will be carried out through the
Ministry of medical services and public health and sanitation, and through
increased participation of the private sector, NGOS, CBOS and communities. The
delivery of the essential packages will be at the District, Health centre,
Dispensary, village and household levels.
C).
THE
This
document form the basis of all HIV prevention and care programmes, including
HIV testing and counseling, prevention of mother-to-child transmission of
HIV/AIDS, sexually transmitted infections and HIV/AIDS, Blood transfusion
safety, quality assurance for voluntary
counseling and testing and diagnostic testing and counseling.
D). NATIONAL GUIDELINES FOR DIAGNOSIS,
TREATMENT AND PREVENTION OF MALARIA.
Malaria
remains a leading cause of morbidity and mortality in
·
To
provide early diagnosis and prompt treatment.
·
To
plan and implement selective and sustainable preventive measures, including
vector control.
·
To
detect early, contain or prevent epidemics.
·
To
strengthen local capacities in basic and applied research to permit and promote
the regular assessment of a country’s malaria situation, in particular the
ecological, social and economic determinants of the disease
E). NATIONALGUIDELINES FOR HIV TESTING AND
COUNSELLING IN
MAY 2008
HIV
testing and counseling is the main entry point to HIV prevention, care, support
and treatment services, it is also central to all HIV programmes nation wide.
The guideline aims at increasing efforts of the
The
national guidelines for HIV testing and counseling in
These
approaches are:-
·
Door
to door testing of HIV.
·
Self-testing.
·
HIV
testing in work place, clients and patients home.
·
Couples
and family testing.
·
Outreach
HIV testing and counseling e. g use of vehicle with private counseling rooms,
teats as counseling rooms and using pre-existing community facilities e. g
church, school or market building.
·
Use
of camel or bicycle mobile outreach mechanism.
·
Moonlight
voluntary testing and counseling.
·
Infant
and child HIV diagnosis.
·
National
HIV testing campaigns.
F). NATIONAL TUBERCULOSIS AND HIV COLLABORATIVE ACTIVITIES GUIDELINES
This
guideline specify major factors responsible for large Tuberculosis disease
burden in
·
Decentralization
of Tuberculosis control services down to the community level to increase access
to these services.
·
Stronger
collaboration between TB and HIV control programmes in order to promote delivery
of integrated TB/HIV services.
·
Private
–public partnership to increase the number of private providers integrated into
the TB service provider network and a sustained public education campaign
couple with health care worker training and support to promote earlier care
seeking and adherence to treatment at community level and better TB case
management by health care providers.
·
Community-based
DOTS (CB-DOTS) and public-private mix for DOTS.
·
Advocacy,
communication and social mobilization strategy aimed at influencing communities
to seek care early when TB symptoms occur and to remain on treatment until this
is completed when treatment is initiated.
G). NATIONAL GUIDELINES FOR QUALITY OBSTETRICS AND PERINATAL CARE
This
guideline emphasizes that integrated reproductive health as the best approach
in reducing the burden of morbidity among women and children. The guidelines
focuses on:-
·
Focused
Antenatal care ( FANC) e. g .
ü Malaria in pregnancy.
ü Prevention of mother to child
transmission.
ü Tuberculosis.
FANC is platform on which integration of
malaria, TB and PMTCT services are being addressed.
·
Skilled
birth attendant during delivery.
·
Community
action, partnership and male involvement.
·
Prevention
of post partum Hemorrhage. This guideline focuses on reducing maternal
mortality in
H). NATIONAL GUIDELINES ON INTEGRATED MANAGEMENT
OF CHILDHOOD
ILLNESSES ( I.M.C.I).
I.M.C.I is a global strategy developed by world
Health organization on child health and development, and UNICEF, and adopted by
the division of child health, ministry of health,
I.M.C.I guidelines focuses on the four main
symptoms:-
·
Cough
or difficult breathing.
·
Diarrhoea.
·
Fever.
·
Ear
problem.
Other childhood conditions addressed by the guideline
are:-
- Malnutrition
and Anaemia.
- Symptomatic
HIV infection.
- Child’s
immunization and vitamin A status.
I.M.C.T is a key strategy in meeting Millennium
development goal of reducing childhood mortality. None of the above National
health documents are in line with pastoralist health needs.
1.4 . HISTORY OF PASTORALIST FOUNDATION FOR LIFE
Mobile
integrated Health Care Services Project started in form of outreach curative
care services in 22nd May, 2003. This was to improve the Health
status and standards of living of pastoralists communities. This programme was
targeting mobile pastoralists in the remote interior of Moyale District.
The
outreach curative care services programme initiative was through the efforts of
Doctor Pino Bollin, who felt that mobile pastoralist Health care Services needs
are unmet. The aim of the programme was to make Health Services accessible to
mobile pastoralist, since Health Service delivery is centralized at the
District Headquarters and satellite centres.
The
programme was receiving funding from collaboration of medical Doctors-Italy
(C.C.M) through the leadership of Doctor Pino Bollin, as the key representative
of the organisation. The programme was implemented by local staff. The
programme funding cycle ended in December 2009. The programme staff felt the
need for continuation of outreach programme activities and in an integrated
Services version through mobile integrated Health care Services project since
these staff were members of a community based organization (C.B.O)‘’Pastoralist Foundation For Life’’,
the CBO was to develop project proposal for funding in order to make health
care services accessible to the mobile pastoralists.
1.5.
ACHIEVEMENTS OF OUTREACH CURATIVE CARE PROGRAMME
Outreach curative care services programme
achieved the following:-
- Community
capacity building by training community Health workers, Traditional birth
attendants and village Health Community. ie. Community-based Resource
persons for community-based Health care programme. These community-based
resource persons are still active and functioning in the community in
facilitating community-based referrals to Health facilities and mobilizing
community for outreach Health care Services and Health campaigns.
- Community-based
sanitation campaigns using tools purchased and distributed by the outreach
programme.
- Increased
Health conscientisation in the communities in the catchment areas
facilitating reduction of outbreak of diseases such as diarrhoea and cases
of cerebral malaria.
- Increased
self-preventability of diseases, self diagnosis and self-referral for
Health care services by community members as a result of community-based
trainings.
- Supporting
supply of drugs to the Government of Kenya Health facilities to minimize essential
drugs shortages in the remote areas of the District.
- Increased Health care access to
mobile pastoralists in the remote interior of the District, as shown in
the table 1, below:-
TABLE
1: OUTREACH CURATIVE CARE SERVICES STATISTICS
|
Year |
Number of patients who received care |
|
2006 |
12,340 |
|
2007 |
5,866 |
|
2008 |
4,196 |
|
2009 |
5,148 |
|
TOTAL |
27,550 |
Source:
Outreach curative care services statistics, year 2006-2009.
The year 2006 was characterized by outbreak of
Diarrhea diseases in the community due to water shortage and displacement due
to tribal conflicts. This triggered high number of patients seen in the
outreach care services.
2.0 ANALYSIS OF PROJECT
AREA
2.1 SOCIO ECONOMIC
SITUATION
A) PASTORALISM
It is estimated that pastoralist constitute 5.7% of
the total population of sub Saharan Africa.
In
·
Pastoralists
have limited access to basic services – education, Health, water and sanitation
facilities, compared to other inhabitants in
·
Pastoralists
are politically, economically and socially marginalized.
·
Pastoralists
raise a variety of animals and preferably a combination of cattle, sheep, goats
and camels depending on the ecological conditions.
·
Pastoralists
live in a fragile ecology characterized by drought, famines, human and animal
diseases and acts of human aggression.
·
Pastoralists
adopt seasonal migration patterns that are determined by availability of water
and pasture and the prevalence of insecurity.
·
Pastoralists
supplement their livelihood with income generated through small scale trading
and agricultural activities.
·
Pastoralists
most often occupy semi arid or arid regions that are characterized by low
population density, harsh, environmental conditions, erratic distribution of
rainfall and spells of drought that can vary between short term and long term
spells.
Pastoral women experience specific constraints that
put them and their children in a more vulnerable position and affect their
livelihood including their health.
Specific constraints are for example:-
·
Drought,
insecurity, loss of land and other natural resources lead to a greater burden
to secure a regular supply of water, food and firewood.
·
Migration
(permanent or semi permanent) of men in search for income or to maintain the
herds of animals and an increased number of children spending time in schools,
leads to more household tasks and responsibilities for women.
·
In
general women have limited access to formal education, information and skills
and due to the socio cultural context access to and control over income and
other resources are very limited and a low participation in decision making is
common.
With regards to health care, pastoralists are prone
to specific disease pattern due to their pastoralists lifestyle. Factors that influence the health of
pastoralists groups are:-
·
The
proximity of animals that can lead to transmission of diseases between humans
and animals
·
Nutritional
deficiencies due to an unbalanced diet (milk diet) or due to a general shortage
of food during periods of drought.
·
Harsh
environmental circumstances (dry sandy, dusty environment, limited access to
safe water sources, poor housing conditions)
·
Migration
and dispersion that leads to difficulties in obtaining and maintaining
treatment
·
Limited
number of health facilities in the areas inhabited by pastoralists.
B) INFRASTRUCTURE
Pastoral areas have experienced neglect in terms of
communication facilities, roads and markets.
Dry weather roads are the order of the day. Telephone and postal communication are not
only inaccessible but absent in many areas.
Market information for pastoralists products does not reach those who
need it and elite members of the communities and middlemen are known to exploit
the herders, craftsmen and women.
The limited infrastructural improvement in
pastoralist areas can be associated with the neglect that originated from long
term marginalization since the colonial days.
This status continued even after attaining independence such that resource
allocation was not equitably distributed between the high and low potential
regions of the country. This on the
other hand could be attributed to the general understanding that the pastoral
economy is subordinate to the other forms of economic occupation in other parts
of the country.
This thinking has led to biased development and
construction of facilities such as schools, colleges and hospitals in the
areas. Road network and communication is generally poor in pastoralist occupied
areas. In places where there roads, they
are poorly maintained and risky to use with certain vehicles. In addition, the traffic movement is very low
and in many instances insecurity along the roads has influenced the volume of
potential travelers due to banditry.
This status has made traveling very expensive where individuals have to
wait for convoys or use police escort services.
In respect to health service delivery, the poor
infrastructure negatively affects provision of health services to the people
living in this district. The
inaccessibility to many settlement centres makes it very difficult to deliver
services successfully to the community.
Natural disasters such as floods made the situation even worse.
C)
SETTLEMENT PATTERNS
The semi arid fringes are relatively
densely populated, whereas the arid interior, is sparsely populated. Settlement patterns are determined, mainly by
availability of services for the semi settled pastoralists and by availability
of pastures as well as water for the nomadic pastoralists. Agricultural activities and establishment of
administrative locations where government employees are found are other places
where permanent settlements have emerged.
Expansion of satellite centers in pastoralist
areas provides appropriate places that can serve as health services outreach
centres. On the other hand, the nomadic
nature of the pastoralist communities makes it difficult for follow up
activities especially during periods of relocation of families. In many cases the people have to cover long
distances to reach a health facility from their Manyattas, approximately
150kilometres.
D) SECURITY SITUATION
Pastoralists groups have been portrayed as bandits
and ungovernable in many reports written by “outsiders,”. However, this is not true since these people
have lived peacefully with their own distinct forms of conflict resolution
mechanisms.
Most of the reported insecurity currently being
experienced in pastoral areas has its origin in the proliferation of firearms
from bordering countries. In some cases,
political interference and instigators can be blamed for the poor state of
insecurity.
Security situation is made worse by persistent
droughts that have led to diminishing of natural resources such as pasture,
water and other resources that form the lifeline of pastoralists in the
district.
E) CULTURE
The pastoral production system is profoundly
influenced by culture, mode of living, customs and tradition of the different
groups. Culture is a set of rules, moral
standards and norms that shape human behaviour in a given society. Every society or community identifies with
its culture and traditions and are proud of it.
Culture regulates the organization of the pastoral production system
within the pastoral society according to groups, ages and sexes. Different tasks and bear different
responsibilities during production process, herding, milking, watering, selling
etc.
These roles are gender differentiated according to
the type and conditions of animals (cattle, sheep, goats, camel, donkeys). Decision making is also clearly assigned to
specific groups and gender. The entire
culture is very functional and geared towards the best management practices in a
hostile and highly varying environment, ensuring as best as possible the
survival of the different groups. There
has been a general erosion of culture among the pastoralist groups particularly
due to the influence of external factors.
Fast growing settlement centres have led to settlement of non pastoralists
who introduce their culture to the local groups. Education and exposure has also affected the
lifestyle of different people at different degrees.
The culture of the pastoral tribes in terms of
traditions and beliefs in a way has led to spread of diseases especially the
communicable ones. Age old traditions
such as limited construction of pit latrines, female genital mutilation and indiscriminate
disposal of domestic waste are some of the traditions that are not health
supportive. In addition, biased gender
practices and beliefs have led to discrimination against women and limited
access and ownership of resources.
Polygamy and keeping of multiple partners has exacerbated spread of STI
and HIV among pastoralists groups.
Needs assessment survey conducted by pastoralists
foundation for life (March 2009) revealed the following cultural practices that
inhibit health of women and girls:-
·
Female
genital mutilation. This cultural
practice is 100% practiced in the target communities. Female genital mutilation is associated with
the following negative outcomes on the health of an individual and family unit.
·
Painful
traumatic wounds
·
Wound
sepsis since there is no use of antibiotics to prevent wound sepsis, the practice
is also conducted under unsterile environment.
·
Hemorrhage,
leading to anaemia in cases of severe bleeding.
·
Wound
healing with scar tissue formation which some times leads to urine retention
and obstructed labour
·
Development
of vesico vaginal or recto vaginal fistulae.
This can be psychologically traumatizing experience especially in young
women during the first deliveries.
Fistulae have triggered divorce of women from their husbands.
·
Traumatic
relationship between the husband and wife
·
Prohibition,
of consumption of eggs, and camel products.
These products are a good source of proteins needed during pregnancy,
lactation, growth and development
·
Forced
marriages
·
Marriage
at a young age. Girls marry at the age
between 15-20 years, associated with physiologically system maturity
·
Women
without male children might be divorced leading to multiparity, a high risk
obstetric category associated with maternal mortality
2.2 HEALTH CARE STATUS
The provision of health care is not only a basic need
but also an essential condition for overall development. However National Health statistic show that maternal mortality rate in
In the
In the same period of time there has seen a
significant increase in the number of children diagnosed with HIV/Aids in the
pediatric clinical services in
About 70 children die from diarrhea and related
illnesses in
The leading causes of morbidity and mortality in
The problem in pastoral areas is inaccessibility to
health services, mainly due to poor infrastructure and sparse distribution of
existing facilities. Health issues are
first addressed using traditional methods before modern treatment is sought by
many communities living in Manyattas.
Promotion of Health issues has mainly been undertaken by the government
of
TABLE 2:
TOP TEN DISEASES FOR MOYALE
DISTRICT HOSPITAL FOR
UNDER
FIVE YEARS AGE GROUP
|
No |
Total Diseases |
Number of cases |
|
1 |
Malaria |
10,749 |
|
2 |
Diseases of respiratory system |
10,618 |
|
3 |
Diarrhea |
7,177 |
|
4 |
Pneumonia |
4,140 |
|
5 |
Intestinal worms |
1,891 |
|
6 |
Diseases of skin including wounds |
1,793 |
|
7 |
Eye infections |
1,254 |
|
8 |
Ear infections |
794 |
|
9 |
Dysentery |
370 |
|
10 |
Anaemia |
310 |
|
TOTAL |
39,096 |
|
Source: Mayale District hospital health statistics,
year 2009
Accessibility is bad such that people have been known
to travel up to 50-80km to reach a health facility. In most cases there is no reliable public
transport to facilitate movement to Health facilities.
High mortality rates and malnutrition are common in
pastoral areas due to poor diet.
Immunization coverage has also decreased while incidence of HIV/AIDS has
increased in pastoralist areas. The
common diseases in the area are shown as the top ten diseases in table 2 for
year 2009. Malaria, Diseases of
respiratory system and diarrhea are the most common diseases in the pastoral
areas, causing morbidity and mortality as shown in table 3 below:-
TABLE 3: TOP FIVE CAUSES
OF MORTALITY FOR UNDER FIVE YEARS AGE
GROUP
|
No. |
Top five causes of
mortality |
Number of deaths |
|
1 |
Pneumonia |
24 |
|
2 |
Diarrhea |
13 |
|
3 |
Malaria |
10 |
|
4 |
Anaemia |
8 |
|
5 |
Respiratory infections |
8 |
|
Total |
63 |
|
Source: Moyale district Hospital
Health Statistics, year 2008
Pneumonia, Diarrhoea and malaria
caused 75% (N=47) of the under 5 years mortality.
HIV/AIDS HEALTH CARE
SERVICES STATISTICS
TABLE 1: COMPREHENSIVE
CARE CLINIC (C.C.C) SERVICES STATISTICS,
YEAR
|
Type of care provided |
Number of patients who received care |
||
|
Male |
Female |
Total |
|
|
Prevention of
mother to child transmission. |
- |
24 |
24 |
|
Voluntary
counseling and
Testing. |
10 |
16 |
26 |
|
Tuberculosis
positive cases. |
25 |
30 |
55 |
|
In patients
positive cases. |
20 |
19 |
39 |
|
Child welfare
clinic positive cases. |
2 |
5 |
7 |
|
All others |
17 |
41 |
58 |
|
Sub total |
74 |
135 |
205 |
|
Who
staging: |
|
|
|
|
Stage
1 |
0 |
0 |
0 |
|
‘’ 2 |
0 |
1 |
1 |
|
‘’ 3 |
22 |
37 |
59 |
|
‘’ 4 |
25 |
42 |
67 |
|
Sub total |
47 |
80 |
127 |
|
Patient’s on
ARV’s |
|
|
|
|
Pregnant
mothers |
- |
13 |
13 |
|
Others |
805 |
1047 |
1852 |
|
Sub total. |
805 |
1060 |
1865 |
|
Patient’s not
on ARV’s but Eligible |
14 |
14 |
28 |
|
Post exposure
prophylaxis |
|
|
|
|
Sexual assault |
0 |
1 |
1 |
|
Occupation |
2 |
0 |
2 |
|
Others |
0 |
2 |
2 |
|
Sub total |
2 |
3 |
5 |
|
On prophylaxis:- |
|
|
|
|
Cotrimoxazole |
5562 |
4316 |
6878 |
|
Fluconazole. |
377 |
605 |
982 |
|
Sub total |
5,939 |
4,921 |
7,860 |
Source: Moyale District Health
statistics, year 2009
NB 66% (N = 135) of Sero-positive
cases were women, and they are also the highest population on ARV’S .i.e.
56% ( N = 1047 ) of the patients on
ARV’S. These statistics are from the static Health facilities in Moyale and
Sololo Districts.
TABLE 2: VOLUNTARY COUNSELLING
AND TESTING STATISTICS
|
Type of care provided |
Number
of cases |
||
|
|
Male |
Female |
Total |
|
Counseled |
922 |
882 |
1,804 |
|
Tested |
922 |
882 |
1,804 |
|
Positive |
18 |
39 |
57 |
|
Couples
Counseled |
|
|
38 |
|
Couples tested |
|
|
38 |
|
Both positive |
|
|
0 |
|
discordant |
|
|
1 |
Source: Moyale District VCT
Statistics, Year 2009
NB 51%
( N = 922) of male received voluntary counseling and testing care services.
Women were the majority who were HIV positive i.e. 68.4% ( N = 39 ) as compared
with men.
TABLE
3: DIAGNOSTIC TESTINNG AND COUNSELLING STATISTICS.
|
Type of care provided |
Number
of cases |
||
|
|
Male |
Female |
Total |
|
Counseled- Out
patient department. - In-patient department. |
700 364 |
550 495 |
1,250 859 |
|
Sub total |
1064 |
1045 |
2109 |
|
Tested - Out
patients department. - In - patient department. |
692 368 |
548 500 |
1240 868 |
|
Sub total |
1060 |
1048 |
2108 |
|
Number positive
– Out patient - In - patient |
51 13 |
56 16 |
107 29 |
|
Sub total |
64 |
72 |
136 |
Source: Moyale district hospital diagnostic
testing and counseling statistics,
Year 2009
NB Women
form 53% ( N = 72 ) of sero-positive cases, and therefore women are one of the
high risk category group in pastoralist communities.
TABLE 4: PREVENTION OF MOTHER TO CHILD TRANSMISSION
OF HIV/AIDS AND
ANTENATAL
CARE STATISTICS
|
Type of care provided |
Number of cases |
|
Prevention of
mother to child Transmission of
HIV/AIDS. |
|
|
3,244 |
|
3,244 |
|
53 |
|
1849 |
|
2 |
|
Preventive
ARV’S |
43 |
|
Infant tested
at 6 weeks. |
24 |
|
Infant tested
after 3 months |
15 |
|
HIV positive referred
for follow-up |
|
|
- Mothers |
53 |
|
- Partners |
25 |
|
Infant issued
with preventive ARV’S |
22 |
|
Mothers
counseled on infant feeding options |
191 |
|
Partners – Counseled
|
478 |
|
- Tested |
473 |
|
- Positive |
30 |
|
Antenatal care
visits |
|
|
- New visits |
3189 |
|
- Revisits |
4357 |
|
- Completed |
1090 |
|
Insecticide
treated Nets |
14 |
|
Haemoglobin
estimation < 7 g/dl |
252 |
|
Intermittent
preventive therapy |
|
|
IPT 1: |
2899 |
|
IPT 2: |
2087 |
Sources:
Moyale district hospital health statistics, year 2009
NB. Acceptance of pregnant
mothers for HIV testing was 100% (N = 3244) and for male partners forms 15% (N
= 473). Community-based couple and family testing – using door to door strategy
can increase male partner participation in the fight against HIV/AIDS pandemic.
2.3.
STATEMENT OF THE IDENTIFIED PROBLEM
Health services inaccessibility, causing Human Suffering in pastoralism
is the key problem facing the pastoralists of Sololo district. National and District Health delivery systems
are not tuned to meet pastoralists Health needs.
The killer diseases of
These diseases occur in remote areas and affect the poor pastoralists, a
scenario made worse by inaccessibility or unavailability of Health care for timely and effective
treatment.
These diseases are threatening the life of citizens of nations globally,
demanding global attention, as well as challenging the attainment of millennium
development goals. All nations in the
world are focusing and directing resources to prevent, control and eradicate
these diseases, since they are obstacles to Health and development of Nations.
National Health programees on these global life threatening diseases don not focus on
pastoralists as a special risk category group in
To break the stigma of silence, pastoralists foundation for life
advocates that time has reached to address Health needs of the Pastoralist
through “
2.3.1
CURATIVE
HEALTH SERVICES
The curative and primary health care is offered to
the population through the Health units distributed in the district. The distribution of Health facilities in the
district is as shown in Table 4
TABLE 4: DISTRIBUTION OF
HEALTH FACILTIES IN SOLOLO DISTRICT AND
CATCHMENT
POPULATION
|
Division |
Station |
Catchment population |
Type of Health Facility |
Ownership |
Status |
|
Obbu |
Ramata |
1502 |
Dispensary |
Government
of |
Staffed
and operational |
|
Anona |
1351 |
Dispensary |
Government
of |
No staff
not operational |
|
|
|
5181 |
Hospital |
Diocese
of Marsabit |
Operational |
|
|
Waye –
Godha |
556 |
Dispensary |
Government
of |
No staff
not operational |
|
|
Mado -
Adhi |
934 |
dispensary |
Government
of |
Not
staffed, not operational |
|
|
Sololo
Makutano |
1233 |
dispensary |
Government
of |
Not
staffed not operational |
|
|
Dambala
Fachana |
Dambala
Fachana |
1577 |
Dispensary |
Government
of |
Staffed operational |
|
Ambalo |
1276 |
Dispensary |
Government
of |
Not staffed
Not operational |
|
|
Garba |
750 |
No
Health Facility |
- |
- |
|
|
Uran |
Golole |
1727 |
Dispensary |
Government
of |
Not
staffed not operational |
|
Karbururi |
693 |
No
health facility |
- |
- |
|
|
Uran |
1255 |
Dispensary |
Government
of |
Operational
staffed |
|
|
Uran
Lataka |
978 |
No Health
facility |
- |
- |
|
|
Banale |
85 |
No
health- Facility |
- |
- |
|
|
Walda |
Walda |
1276 |
Dispensary |
Government
of |
Not Operational |
|
Rawana |
312 |
No
health facility |
- |
- |
Source:
There are 8 established Health facilities in the District. 4 facilities are operational currently in the
District, while the other 4 are non functional due to staff shortage. There are three (3) newly constructed
facilities at Waya-Godha, Mado-adhe and Sololo Makutano but not operational due
to staff shortage.
The main problem facing the District population is inaccessibility to
Health Services. Walda Division is the
most affected since it has only one Health facility and not staffed by a
qualified staff. There are a total of 13
out stations which have no accessibility to Health services unless out reach
programme strategy is used to reach them at the remote interior of the
district, since there are no existing Health facilities.
2.4 BENEFICIARIES
AND STAKE HOLDERS
A)
BENEFICIARIES
The
beneficiaries of mobile intergrated Health care Services are the Pastoralist
population living in Sololo district, and include, the Borana, Gabbra, Ajuran
and Ghari ethnic groups. The programme will also target to benefit, Ethiopians
along the
B )
STAKEHOLDERS
Health
care services required in the mobile integrated project area of coverage are
offered by several other groups of people or stakeholders. These include
ministry of medical services and Public Health and sanitation that provides
E.PI, curative care, health education and STI /HIV/AIDS related services, Arid
land resources management, local international NGO’S and UN Agencies, AMREF,
UNICEF, MEDS, RED CROSS, C.C.M, Local NGO’S and CBOS such as FHI-K,CIFA, WORLD VISION,
C.C.S and CIPAD.
The
private sector is also involved in offering health services through private
clinics and nursing homes. Many of these service providers have special
interest in the pastoralist people or operate on humanitarian ground. Health
services delivery to the pastoralist is not tuned to meet their needs. There are no mobile Health services to reach
mobile pastoralist in the range lands.
Appendix 1
give details of services offered by identified stakeholders involved in provision
of varies health services. Their interests, strengths, weaknesses, and possible
areas of collaboration with pastoralist foundation for life mobile dispensary
project are also elaborated.
3.0 PROJECT
INTERVENTIONS
3.1. OVERALL
OBJECTIVE ( GOAL)
To contribute
to the attainment of Health for the pastoralist of Sololo District through
provision of acceptable, affordable and accessible Health care Services.
3.2.
PURPOSE
The project purpose is fivefold:-
3.2.1
To reduce the spread
of HIV infection in pastoralist in Sololo District in
3.2.2
To
lessen the impact of HIV epidemic on pastoralist communities of Sololo
District.
3.2.3 To improve referrals and linkages to
comprehensive care, HIV prevention,
treatment and social support.
3.2.4
To improve family planning and HIV
integrated services within
the Pastoralist Communities of
Sololo District.
3.2.5 To reduce maternal and
childhood morbidity and mortality Sololo
District in
3.3 SPECIFIC OBJECTIVES
3.3.1 To
promote community based HIV testing and counseling by conducting door to door
HIV testing and counseling, HIV testing and counseling at homes of patients on
ART, couples and their families testing and counseling, testing and counseling
of children of deceased or HIV infected parents, providing provider initiated
testing and counseling, voluntary testing and counseling and providing outreach
HIV testing and counseling services to mobile communities.
3.3.2 To
promote prevention of mother to child transmission of HIV/AIDS by conducting
HIV testing and counseling of pregnant and postnatal mothers, providing ARV and
cotrimoxolazole prophylaxis, early infant diagnosis, referrals of DBS specimen
for HIV exposed infants, facilitating partner testing and counseling, conducting
STI, TB and anaemia screening, organizing infant feeding and counseling
workshops, SP prophylaxis and supporting infant feeding options for HIV exposed
infants.
3.3.3 To
improve community care and support for people living with HIV/AIDS and orphans
by conducting HIV/AIDS risk and vulnerability assessment workshops,
facilitating formation of PLWHA’S groups, conducting adherence counseling
workshops, support supply of ARVT and opportunistic infections drugs,
conducting trainings and exchange visits for PLWHA’S, supporting income
generating projects for PLWHA’S, Nutritional supplementation for PLWHA’S,
supply of school materials and uniforms for orphans and vulnerable children,
payment of school fees for orphans, payment of health care bills for PLWHA’S
and orphans, supporting trainings of treatment supporters, supporting community
based linkages for PLWHA’S, support HIV/AIDS support groups and supporting
referral of PLWHA’S for comprehensive care services.
3.3.4 To
strengthen reproductive health care service by facilitating distribution of
male and female condoms, supporting supplies of contraceptives, screening of
STI, treatment and referral, delivery of antenatal care package, conducting
reproductive health community awareness workshops, and supporting integration
of family planning and reproductive health into testing and counseling.
3.3.5 To
improve maternal health care services through delivery of focused antenatal care package, supporting skilled
birth attendant campaigns, supporting monitoring of pregnancies at outreach
services delivery points, supporting vitamin A supplementation for lactating
mothers, supporting nutritional supplementation for vulnerable pregnant and
lactating mothers and supporting treatment of medical conditions in pregnancy.
3.3.6 To
improve child health care services through supporting clinical and community
I.M.C.I, conducting mobile immunization services, supporting nutritional
supplementation for children with acute malnutrition, supporting supply of essential
drugs for I.M.C.I and supporting school Health programme services.
3. 4 STRATEGIES
3.4.1
Community-based HIV testing and
counseling promotion
3.4.2 Prevention of mother to child transmission of
HIV/AIDS promotion.
3.4.3
Community care and support for people
living with HIV/AIDS and
orphans improvement.
3.4.4
Reproductive
health care services strengthening .
3.4.5
Maternal
health care services improvement.
3.4.6 Child health care services improvement.
3.5 STRATEGIES AND ACTIVITIES
3.5.1. STRATEGY:
COMMUNITY-BASED HIV TESTING AND COUNSELLING
PROMOTION.
ACTIVITIES:
1.1
Support door to door HIV testing and
counseling.
1.2
Support HIV testing and counseling at homes of
patients on Antiretroviral
therapy.
1.3
Support couples and their family testing and
counseling for HIV.
1.4
Support HIV testing and counseling for
children of deceased or HIV
infected mothers.
1.5
Support outreach HIV testing and counseling
services.
1.6
Support youth out of school and school-based
HIV/AIDS programmes.
1.7
Support work place HIV testing and counseling.
1.8
Support community mobilization.
1.9
Support provider initiated testing and
counseling.
1.10
Support voluntary testing and counseling.
3.5.2 STRATEGY:
PREVENTION OF MOTHER TO CHILD TRANSMISSION OF
HIV/AIDS PROMOTION
ACTIVITIES.
2.1
Support
HIV testing and counseling for pregnant and postnatal mothers.
2.2
Support
ART prophylaxis for HIV positive pregnant mothers and HIV exposed infants.
2.3
Support
early infants HIV diagnosis.
2.4
Support
referral of DBS of HIV exposed infants to national laboratories e. g KEMRI.
2.5
Facilitate
partner testing and counseling.
2.6
Support
cotrimoxazole prophylaxis.
2.7
Support
SP prophylaxis for pregnant mothers.
2.8
Support
supply of insecticide treated mosquito nets to HIV positive pregnant and
postnatal mothers.
2.9
Conduct
STI, TB, Malaria and anaemia screening for pregnant mothers.
2.10
Support
infants early HIV diagnosis and feeding counseling
workshops.
3.5.3 STRATEGY:
COMMUNITY CARE AND SUPPORT FOR PEOPLE
LIVING WITH HIV/AIDS AND ORPHANS IMPROVEMENT
ACTIVITIES
3.1
Conduct
community HIV/AIDS risk and vulnerability assessment workshops.
3.2
Support
formation of groups of people living with HIV/AIDS.
3.3
Conduct
adherence counseling workshops for people living with HIV/AIDS and treatment
supporters.
3.4
Support
supply of ART and opportunistic infections drugs.
3.5
Conduct
training of self-help projects for people living with HIV/AIDS.
3.6
Support
exchange visit for people living with HIV/AIDS.
3.7
Support
income generating projects for people living with HIV/AIDS.
3.8
Support
nutritional supplementation for people living with HIV/AIDS.
3.9
Support
supply of school uniforms for orphans and vulnerable children.
3.10
Support
payment of school fees for orphans and
vulnerable children.
3.11
Support
payments of health care bills for people living with HIV/AIDS and orphans.
3.12
Support
trainings of treatment supporters.
3.13
Support
community-based linkages for people living with HIV/AIDS.
3.14
Support
HIV/AIDS support groups.
3.15
Support
referrals of people living with HIV/AIDS for comprehensive care services.
3.16
Support
prevention with positives meetings/workshop.
3.5.4 STRATEGY: REPRODUCTIVE HEALTH CARE
SERVICES
STRENGTHENING
ACTIVITIES
4.1 Support distribution of male and female
condoms.
4.2 Support supply of contraceptives.
4.3 Support screening of sexually transmitted
infections, treatment and referrals.
4.4 Support delivery of antenatal care
package.
4.5 Support reproductive health community
awareness workshops.
4.6 Support integration of family planning and
reproductive health into HIV testing and counseling.
3.5.5
STRATEGY: MATERNAL HEALTH CARE SERVICES
IMPROVEMENT
ACTIVITIES
5.1 Support delivery
of focused antenatal care package to pregnant mothers.
5.2 Support skilled birth attendance campaigns.
5.3 Support monitoring of pregnancies at outreach
service delivery points.
5.4 Support vitamin A supplementation for
lactating mothers.
5.5 Support nutritional supplementation for
vulnerable pregnant and lactating Mothers.
5.6 Support treatment of medical conditions in
pregnancy and child birth
3.5.6 STRATEGY: CHILD HEALTH CARE SERVICES
IMPROVEMENT
ACTIVITIES
6.1
Support clinical and community integrated management of childhood illnesses
(I.M.C.I.).
6.2
Conduct mobile immunization services.
6.3
Support nutritional supplementation for children with acute malnutrition
(I.M.A.M.).
6.4
Support supply of essential drugs for I.M.C.I.
6.5
Support school health programme services.
3.6 EXEPECTED OUTPUT/RESULTS
1.0 Community-based HIV
testing and counseling promoted.
2.0 Prevention of
mother to child transmission of HIV /AIDS promoted.
3.0 Community care and
support for PLWHAS and orphans improved.
4.0 Reproductive health
care services strengthened.
5.0 Maternal health care
services improved.
6.0 Child health care services
improved.
3.7 RESULTS AND ACTIVITIES
The
programme co-ordinator after consulting the community, community organized groups and
key stakeholders in the programme catchment area, identified 6 expected
results/out put or services to be delivered by the programme. Under each of the
results, relevant activities were identified that show how the programme goods
and services will be delivered to the beneficiaries. Details of the result, activities,
objectively verifiable indicators and target for the activities are given in
programme planning matrix or logical framework matrix (Appendix 2): The results
and respective activities are as follows:-
1.0.
COMMUNITY-BASED HIV TESTING AND COUNSELING PROMOTED
1.1.
Support door to door HIV testing and counseling
Pastoralist
foundation for life programme aims at accessing HIV services to pastoralist at
their homes, this is to facilitate prevention of the epidemic at the range
lands. The programme will use outreach/mobile strategy to reach the pastoral
community for HIV testing and counseling services. The programme also aims at targeting villages
and households, using the door to door strategy for HIV testing and counseling.
The programme team will be camping at specific sites for service delivery
points in the programme catchment area for a period of one to two weeks in order
to deliver mobile services package for pastoralist community. The programme
aims at providing HIV testing and counseling to 400 households (I.e 2000
people) within a period of 3 years.
1.2. Support
hiv testing and counseling at homes of patients on Antiretroviral
Therapy ( ART).
The aim of
the programme is to go beyond the index patient, and reach to the family
members for HIV testing and counseling. This is to promote prevention, care and
support at family unit level. Accessibility of HIV testing and
counseling for pastoralist community in the rangeland is a dream, it is never
conducted, and therefore pastoralists are neglected population in HIV/AIDS
epidemic. The programme aims at targeting 200 households in the
programme catchment area within the time scale of the programme.
1.3. Support
couples and their families HIV testing and counseling
Prevalence
of HIV discordance is high in
1.4.
Support HIV testing and counseling for children of deceased or HIV
infected mothers
This activity
is aimed at accessing early childhood HIV diagnosis in the pastoralist
community at the rangelands. It is also aimed at facilitating care, treatment
and social support. The programme will target at least 50 children in three years
time.
1.5.
Support outreach HIV testing and counseling services
Pastoralist
foundation for life programme believes outreach/mobile integrated programme as
the core strategy for releasing the programme goals and objectives. It is
through this strategy that the marginalized pastoralist at the rangeland will
get access to HIV testing and counseling services and receives linkage to care,
treatment and social support. The programme proposes to use the following
methodologies:-
·
Mobile
sites using tents.
·
Market
centres, targeting market days.
·
Pastoralist
water points, targeting herders.
·
Pastoralist
ceremonies days.
·
Work
place, targeting schools in ASAL regions.
·
Patients
homes.
·
Clients
homes.
·
Immunization
campaigns.
·
School
games i.e during interschool competition.
·
Outreach
HIV testing and counseling at night for pastoralist herders.
The programme aims at implementing the
following outreach/mobile integrated activities/services:-
·
Home-based
HIV testing and counseling.
·
Prevention
of mother to child transmission of HIV/AIDS.
·
Provider
initiated testing and counseling (P.I.T.C.).
·
Antenatal
care package.
·
Family
planning services.
·
Tuberculosis
screening and referrals.
·
Malaria
prevention and control.
·
Voluntary
testing and counseling.
·
Earlier
infants diagnosis e. g DBS collection and referrals.
·
ART,
SP and cotrimoxazole prophylaxis.
·
Linkages
to comprehensive care clinic services.
·
School
health programmes i.e school-based HIV/AIDS programme.
·
Youth-out
of school programmes.
·
Work
place testing and counseling e. g in schools, kiosks.
·
Community
mobilization and health education. The programme team will settle within
specific sites in the catchment area where the pastoral community can access
services for at least one to two weeks. The aim of the programme is to target 16
mobile visits to the pastoral communities a period of 3 years i.e 48 mobile
visits targeting 900 people in three years.
1.6.1.
Conduct workshops for youth-out of school
Youth form
a critical section of the society, because they are the basis of the
future families to be in the
community and future leadership of the society. They are currently facing
life-threatening socio-economic problems, such as.
·
HIV/AIDS
pandemic.
·
Poverty
and unemployment.
·
Drug
abuse alcoholism.
·
Pressure
of modern living.
The programme
proposes to facilitate capacity building workshop at the rangelands targeting
mobile pastoralist youth. The key topics will be as follows:
·
HIV/AIDS
and youth in pastoralism.
·
Benefit
of HIV testing and counseling to the individual, family and community.
·
Management
of self-help projects and winning resources.
·
Leadership
and development.
The aim of the programme is also to conduct
HIV testing and counseling at the end of every workshop. The programme will
strictly practice the core principles of HIV testing and counseling i.e
consent, confidentiality and counseling, as per the national guidelines for HIV
testing and counseling in
They are
also to be active in HIV/AIDS campaigns and community education on the
pandemic. As, a strategy to reduce risk and vulnerability, the youth out of
school are expected to operate self-help projects. This is to orientate them on
socio-economic lifestyle and help in the fight against poverty. It is also a strategy
to fight grassroot poverty and build an economic base of pastoralist
households. Youth-out of school programme approach could be a double strategy
that is to fight disease and poverty.
The
programme will organize and facilitate 3 workshops, each attended by 30
participants. i.e targeting 90 participants in 3 years. These workshops will be
conducted at the community level, as part of mobile/outreach integrated
programme.
1.6.2.
Conduct workshops for school-based HIV/Aids programme
The aim of
this activity is to conscientize members of the education sector on the
benefits of knowing once HIV status. It aims also at broadening partnership in
the fight against the pandemic particularly in the marginalized pastoralist
regions. The programme proposes to organize and conduct 3 workshops, each to be
attended by 40 participants, totaling to 120 participants in 3 years. The
following topics are to be focused during workshops.
·
Adolescent
and HIV/AIDS pandemic in pastoralism.
·
Benefits
of knowing ones HIV-Sero-Status.
·
Impact
of HIV/AIDS in education sector and pastoralist life style e. g economy.
·
Prevention,
care, treatment and social support for PLWHA’S.
HIV
testing and counseling will be part of the workshops, as an integrated activity
in the programme.
1.6.3.
Conduct training of school-based counselors on HIV testing and counseling
The
programme aims at training 10 school-based counselors for HIV testing and
counseling. This is to establish a community-based structure for fighting and
building awareness on HIV/AIDS at the pastoralist schools located in the
rangeland areas. i.e those that are faraway from the satellite centres. These
counselors will be conducting HIV testing and counseling in schools.
1.7. Support work place HIV testing and
counseling.
The
programme aims at targeting primary and secondary schools, kiosks in
pastoralist satellite centres, CBO’S and other work places in the pastoralist
region within the programme catchment area. This activity aims at accessing HIV
testing and counseling services to personnels at work places in marginalized
areas of the pastoralist community. The programme also aims at organizing and
conducting 3 workshops, attended by 20 participants, which will be a total of
60 participants in 3 years. The aim of the workshops is to create awareness and
facilitate HIV testing and counseling.
1.8. Support
community mobilization.
Community
mobilization is key to orientating individuals, families and communities
towards programme services. It is also essential for explaining influential
figures in the community available services. When using community mobilization
strategy, the programme will focus on the following:-
·
Identify
key people in the community who can ultimately facilitate the dissemination of
information.
·
Aims
to create a forum for dialogue. Sensitization messages are most effective when
they are discussed and debated with the community. Encourage participants to
ask questions, voice their opinions and expand or modify any aspect of the
community mobilization strategy.
·
When
dealing with community influential figures, highlight the important of their
participation in programme activities.
The
programme aims at organizing and conducting community leaders workshops,
targeting 40 participants and community mobilizers workshop for 10
participants. 3 workshops for community members targeting 150 participants will
also be conducted. The programme propose to be paying a monthly stipend for
three( 3) community mobilizers for a period of two years, at a rate of
Kshs.4000/= per month.
1.9.
Support provider initiated testing and counseling
This
activity is aimed at offering HIV test to clients or patients regardless of
their reason for attending mobile services. The programme aims at making PITC
as part of routine medical care before the onset of HIV related –symptoms at outreach
services delivery points.
The
programme team will provide counseling and testing at the point of care and an
HIV test results.
The
programme will target at least 500 clients and patients for PITC within a
period of 3 years.
1.10. Support
voluntary counseling and testing
This
activity provide a situation whereby an individual, couple or a group actively
seek out HIV testing and counseling at the site of service delivery point i.e
at mobile sites or people’s homes. This activity puts emphasis on risk
reduction counseling to help the clients or couples to identify plans for the
prevention of HIV transmission or acquisition. The programme will target at
least 200 clients in 3 years.
2.0.
PREVENTION OF MOTHER TO CHILD TRANSMISSION OF HIV / AIDS PROMOTED
2.1
Support HIV testing and counseling for pregnant and postnatal mothers
(PMTCT)
The aim of
this programme activity is to prevent HIV transmission on children. This is by
promoting and strengthening the following activities:-
·
Promotion
of ABC, voluntary counseling and testing for HIV negative young women
·
Prevention
of unintended pregnancies in HIV infected women through voluntary family
planning.
·
Universal
HIV testing for pregnant women.
·
ARV
prophylaxis for HIV positive mothers and exposed infants. Counseling and testing for negative mothers
and partners.
·
Early
infant HIV diagnosis.
·
Prevention
and treatment of sexual transmitted infection.
·
Provision
of family planning services e.g postpartum family planning.
·
Referrals
to comprehensive care clinic for follow up.
·
Male
involvement for HIV prevention, care and support.
·
Infant
feeding counseling e.g exclusive breast feeding.
·
Administration
of highly active antiretroviral therapy for HIV positive eligible mothers.
This
activity is part of child survival strategy in HIV /AIDS pandemic. PMTCT
activity will be provided through mobile / outreach services. It is aimed at
reaching pastoralist who are staying far away from static service delivery
points e.g health facilities.
2.2 Support antiretroviral therapy
prophylaxis for HIV positive pregnant mothers and HIV exposed infants
The
programme aims at facilitating this activity together with partner agencies, particularly
static Health facilities in order to prevent HIV transmission on children. 250 pregnant and postnatal mothers and 50
exposed infants will be targeted by the programme mobile/outreach integrated services
within the programme planed period.
2.3 Support early infant HIV diagnosis
The
programme activity aims at performing HIV testing of mothers and children for
early infant diagnosis. This is to be implemented by performing the following:-
·
Routine
HIV screening for all mothers having 6 weeks old infants whose HIV Status is
not known. Sick children in service
delivery points to establish HIV exposure/infection status.
·
Diagnostic
HIV antibody testing for all mothers detected with TB or STI’S who have young
children, unless they decline i.e opt out.
·
Diagnostic
HIV antibody testing and counseling for all sick children attending service
delivery point.
·
Routine
dry blood spot (DBS) for DNA PCR for all infants known to be HIV exposed at 6
weeks and all HIV exposed sick infants below 12 moths
·
HIV
positive mothers and having unknown status attending service delivery point, at
9 months and at 18 months for confirmatory antibody test. The programme aims at targeting 250 mothers
and 50 children within 3 years.
2.4
Support referrals of dried blood spot samples of HIV exposed infants to
national
laboratories
Referral
of blood samples to national laboratories is a key strategy for early infant
HIV diagnosis. This activity will facilitate early care, treatment and support
for HIV positive children. The programme aims at collecting dried blood spot
samples during mobile outreach integrated services and facilitating referrals
to KEMRI. 50 dried blood spot samples specimen will be collected and referral
to KEMRI by the end of the programme.
2.5. Facilitate
partner testing and counseling
This
activity aims at prevention of HIV transmission and assess for couple discordance.
It also aims at facilitating disclosure and social support for HIV positive
couples. The programme will target at least 250 couples in 3 years time.
2.6. Support
co-trimoxazole prophylaxis for HIV positive persons.
Co-trimoxazole
prophylaxis for HIV positive people provides protection against many opportunistic
infections such as:-
·
Bacterial
pneumonia.
·
Malaria.
·
Pneumocystic pneumonia.
·
Toxoplasmosis.
·
Salmonella.
Administration
of co-trimoxazole on daily basis will improve the quality of life and prevent
deaths from opportunistic infections. The programme aims at facilitating
referral of HIV positive people to comprehensive care clinic for provision of
co-trimoxazole. The programme will target to refer at least 300 people within a
period of 3 years.
2.7. Support
sulfadoxine pyrimethamine ( SP) prophylaxis for pregnant
mothers
Malaria is
one of the top development concerns for
The programme proposes to use DOT strategy
when implementing this activity. A total of 200 pregnant mothers are to be
targeted by the programme for SP administration.
2.8. Support
supply of insecticide-treated mosquito nets.
The
programme aims at facilitating distribution of ITMNS to people who are HIV
positive. This is aimed at preventing malaria and improving the quality of life,
and therefore use of mosquito nets aims at avoiding man and vector contact. Preventing
mortality associated with malaria. The programme through mobile integrated
Services aims at distributing 400 insecticide treated mosquito nets.
2.9. Conduct
STI, TB, malaria and anaemia screening for pregnant mothers
The
programme aims at integrating STI, TB, malaria and anaemia screening in service
delivery to pregnant mothers, because of the following:-
·
STI
increases the likelihood of acquiring HIV infection.
·
HIV
increases the likelihood of developing tuberculosis.
·
Pregnancy
also increases the risk of developing tuberculosis. Tuberculosis is the major
opportunistic infection in HIV and the leading killer of people living with
HIV/AIDS.
·
The
major health effect of malaria on the pregnant mother is Anaemia.
The
programme aims at screening pregnant mothers and facilitating referral for
treatment at the static health facility. 150 pregnant mothers are targeted to
be screened and referred for care in 3 years period.
2.10. Support
early infant HIV diagnosis and infant feeding counseling
workshops
These workshops will aim at targeting the
following beneficiaries;
·
Pregnant
women.
·
Breastfeeding
mothers, less than 12 months.
·
Couples
within reproductive age brackets.
·
Young
men and girls.
·
Postnatal
mothers.
The
programme aims at focusing on the following key themes/areas.
·
Mother
to child transmission of HIV/AIDS.
·
Benefits
of breastfeeding in growth and development.
·
Nutritional
care and support.
·
Infant
feeding options e.g.
ü Exclusive breastfeeding.
ü Replacement feeding e.g. AFASS.
ü Complementary feeding.
·
Nutrition
counseling for HIV positive mothers.
·
Maternal
and infant conditions facilitating HIV transmission.
A total of 120 participants will be targeted
by the programme.
3.0.
COMMUNITY CARE AND SUPPORT FOR PEOPLE LIVING WITH HIV/AIDS AND ORPHANS
IMPROVED.
3.1. Conduct
community HIV/AIDS risk and vulnerability assessment
workshops.
The aim of
this activity is to facilitate community understanding of the dynamics of
HIV/AIDS pandemic in their own communities. It is also to deeply analyze the
pattern of transmission based on really life experience of the community. The
planned programme workshops will facilitate community understanding of the
pandemic by focusing on the following key topics.
- Disasters
( e.g. drought, man-made conflicts, cattle rustling) and transmission of HIV in pastoralism.
- Displacements,
migration and labour mobility to towns following droughts and transmission
of HIV/AIDS.
- Pastoralist
stress coping mechanisms and strategies ( e.g. self-restocking job seeking
attitudes) and transmission of HIV/AIDS.
- Pastoralism,
gender discrimination and negative cultural practices and HIV/AIDS
transmission.
- Community
risk and vulnerability action plan for implementation.
A total of
4 workshops will be conducted, and will be attended by 80 participants.
3.2. Support
formation of groups of people living with HIV/AIDS
Formation
of groups of people living with HIV/AIDS in pastoralist community is to form a
basis for establishing a network of pastoralist living with HIV/AIDS
organization. A group of people living with HIV/AIDS strategy aims at the following:-
·
Fight
against HIV/AIDS and poverty resulting from impact of HIV/AIDS.
·
Facilitate
formation of self-help groups.
·
Activist
in the fight against discrimination and stigmatization in pastoralist
community.
·
Mobilizers
of pastoralist communities in the fight against the pandemic.
·
Promoting
adherence to ART at community level.
·
Form
a community-based structure in the conscientisation of the community.
·
The
progamme propose formation of five groups of people living with HIV/AIDS.
3.3 Conduct
adherence counseling workshops for people living with HIV/AIDS
and treatment supporters
The programme
aims at conducting adherence counseling workshops at the community level,
particularly those that are close to health facilities with comprehensive care
clinics. The following
beneficiaries will be targeted:-
·
People
living with HIV/AIDS.
·
Guardian
and parents of HIV positive children.
·
Treatment
supporters.
·
HIV
positive pregnant and postnatal mothers.
The
programme aims at focusing on the following key topics:-
·
Highly
active Antiretroviral therapy ( HAART).
·
Benefits
of ARTS and role of ARTS in PMTCT.
·
Benefits
of good adherence.
·
Outcomes
of non-adherence e.g.
-Treatment failure.
-Viral resistance.
-Poor quality of life and death.
·
Side
effects and adverse effects of ART drugs.
·
Types
of opportunistic infections.
·
Opportunistic
infections drugs and their uses.
·
WHO
clinical staging-signs and symptoms.
·
Co-trimoxazole
prophylaxis.
·
ART
prophylaxis e.g. in
-Pregnancy.
-Post-exposure prophylaxis.
-Rape victims.
·
Fluconazole-secondary
prophylaxis.
·
Patient
monitoring e.g.
-CD4 counts.
-Viral load.
-Immunological.
·
Role
of family and community in promoting adherence and basic counseling skills.
The
programme will target 80 participants.
3.4. Support
supply of antiretroviral and opportunistic infection drugs
This
activity is aimed at forming a partnership with static Health facilities within
the pastoralist community catchment area for delivery of care to people living
with HIV/AIDS.
The
programme aims at forming community linkages for people living with HIV/AIDS to
static health facilities with comprehensive care services. The programme will
also facilitate patients’ referrals to service delivery points and formulate a
scheduled follow-up mechanism for monitoring service delivery to people living
with HIV/AIDS.
NASCOP
will be expected to facilitate supplies of ART’S and OI’S drugs to be used in
comprehensive care clinic centres. The programme will facilitate referrals of
50 people for comprehensive care services.
3.5.
Conduct trainings of self-help projects for people living with HIV/AIDS
The aim of
the programme is to organize and conduct training of people living with
HIV/AIDS on the concepts of self-help projects. The training will focus on the
following areas:-
·
Micro-enterprise
management and linking livestock as a resource in poverty alleviation at
households in pastoralism.
·
Principles
of sustainable development and winning of resources.
·
Group
dynamics and self-help projects.
·
Project
information management.
·
Development
of annual implementation plans. i.e. micro planning.
·
Self
- help project goal is to generate income for people living with HIV/AIDS, to
meet their basic needs. It is a poverty alleviation strategy as well as
HIV/AIDS mitigation strategy, a contributor of poverty in society.
These
projects can be utilized as a social mobilization strategy, to facilitate the
acceptance of the disease in human population and build a culture of positive
living with the disaster like any other chronic disease or disability. Self-help
projects may be a basis for community organization or movement in the fight
against HIV/AIDS pandemic in the society.
Self-help
project, as community mobilization and organization strategy can generate a
basis for people driven self-determination and sustainable development. These
projects also form key entry points for social transformation and a strategy
for groups to use as a tool for winning resources for themselves from donor
agencies, banks, ministerial grants and other funding agencies targeting to
benefit community groups.
Self-help projects, if successful can be empowering
communities, build groups spirit of self- reliance and generate the energy for
creativity. These are essential elements for community self-organization and participation.
A total of 80 participants will be trained in 3 years time.
3.6. Support exchange visit for people
living with HIV/AIDS
This
activity aims at maximizing learning experience for people living with HIV/AIDS
on the challenges affecting their lives, so that they can live positively. The
programme will facilitate two exchange visits to national or specific
established groups of people living with HIV/AIDS.
3.7. Support
income generating projects for people living with HIV/AID
This
activity is expected to enable people living with HIV/AIDS to be self-reliant
and play an active role in community development. It will also strengthen
psycho-social support for PLWHA’S and build sense of belonging of the members
in the group. The programme will propose to facilitate two projects i.e:-
·
Rental
houses and lodging project at a cost of Ksh.1,040,000 targeting HIV positive
dropout pastoralist at satellite centres.
·
Camel
dairy (milk) project. At a cost of Ksh. 300,000.i.e. 10 camels at ksh. 30,000
each, targeting pastrolist at the rangeland who are HIV positive. Community is
expected to contribute land for building the rental houses and lodgings.
3.8.
Support nutritional supplementation for people living with HIV/AIDS .
Pastoralist
foundation for life CBO aims at facilitating provision of food for HIV positive
people particularly during the periods of drought where food deficit is a reality
at pastoralist households. Malnutrition causes immunodeficiency as well as
HIV/AIDS disease, leading to increased morbidity and mortality of people with
HIV/AIDS.
The
programme will aim at purchasing 50 bags of 90kg of maize, 30 bags of 90kg of
beans, 30 bag of 50kg of rice, 30 bags of 25kg of unimix and 20 jericans of 20
litres of vegetable oil, and distribute to HIV positive people through
integrated outreach programme in collaboration with partner agencies. This
activity will be implemented at a cost of ksh. 965,500.
3.9. Support
supply of school uniforms for orphans and vulnerable children
Pastoralist
foundation for life will aim at also targeting HIV/AIDS orphans and vulnerable
children for education services. A total of 20 children will be
targeted to benefit for school uniform, at a rate of ksh. 4000/= per child per
year for a period of 3 years.
3.10. Support
payment for school fees for orphans and vulnerable children
Pastoralist
foundation for life believes education as an essential tool for human
liberation and development of a nation, and therefore it proposes to facilitate
education of orphans and vulnerable children in pastoralist community. The
programme aims at targeting 10 secondary students who are HIV/AIDS orphans and
vulnerable children, by facilitating payment of school fees at a rate of
ksh.8000 per term and a transport fee of ksh.2000/= per term for a period of 3
years.
3.11.
Support for payment of health care bills of people living with HIV/AIDS
and orphans
As result of burden of health care bills, the
programme propose to facilitate payment of hospitalization bills for PLWHA’S and orphans for the pastoralist
community in the rangelands and pastoralist drop-outs at satellite centres,
this is because of fragile and unstable pastoralist economy. The total health
care bill budget that the programme will propose for payments will be
ksh.600,000/=, targeting for 20 beneficiaries in 3 years.
3.12.
Support trainings of treatment supporters.
Pastoralist
foundation for life aims at implementing this activity in order for people
living with HIV/AIDS to receive quality care and longevity of life. The programme will conduct 4 workshops,
targeting 80 participants. The key topics/themes to be focused are as follows:-
·
Components
of home-based care.
·
Home-based
Care Nursing care.
·
Basic
counseling skills.
·
Safe
water and hygiene.
·
Nutrition
care.
·
Benefits
of ART and OI’S drugs.
·
Benefits
of good adherence.
·
Benefits
of HIV-sero-status disclosure.
·
The
role of family and community in care for PLWHA’S.
·
Stigmatization
and discrimination of PLWHA’S.
·
Core
principles of HIV testing and counseling.
These
workshops will be conducted as part of mobile/outreach integrated services at
the community level, targeting pastoralist.
3.13.
Support community-based linkages for people living with HIV/AIDS
The aims of
implementing this activity is to form abroad base partnership for the
implementation of programme activities in order to attain the desire goals and
objectives. The programme aims at organizing and conducting 6 stakeholders
meetings, and attended by 60 participants in 3 years. The meetings will be
attended by the following:-
·
Community
leaders.
·
Faith-based
organization leaders.
·
Non-governmental
organizations.
·
Community
– based organization.
·
Community
– socially organized groups.
·
Youth
representatives.
·
Women
group representatives.
·
Ministry
of medical services and public health and sanitation.
·
Humanitarian
organization.
The programme will also plan to conduct 2 workshops
for stakeholders. In this workshops the following key areas/themes will be
focused on:-
·
Benefits
of partnership in development projects.
·
Community
resource mapping for the benefits of people living with HIV/AIDS.
·
Role
of stakeholders in the fight against HIV/AIDS pandemic.
·
Assessing
community potentials for development.
·
Development
of action plan.
A total of 60
participants will be targeted to benefit from the training within 3 years.
3.14.
Support HIV/AIDS support groups.
Pastoralist
foundation for life implements this activity in order to perform monitoring of
support groups performance at the community level. This is to detect the
deviation from the proposed plan, and design corrective action / measures in
time. It is also monitoring precise target milestones and target for physical
performance.
The
program will focus to plan and conduct 3 workshops, attended by 60 participants
by the end of 2012. The workshops will focus on the following themes / areas:-
·
Group
dynamics and human relationships.
·
Community
based linkages strategies.
·
Resource
mobilization for people living with HIV / AIDS.
·
Principles
of partnership in development.
·
Development
of action plan.
Meetings will also be scheduled as a follow-up
mechanism for HIV /AIDS support groups. These meetings will be conducted at least
two times a year.
3.15 Support
referral of PLWHAS for comprehensive care services
Due to
inaccessibility of comprehensive care services for pastoralist at the
rangeland, the programme will focus on referring patients / clients to static
health facilities. Pastoralist foundation for life CBO will use mobile
/outreach integrated services, as a detection strategy for pastoralist patients
/ clients in needs of comprehensive care services. Referral forms and registers
will be used to document this activity. A total of 300 people will be targeted
for referrals for comprehensive care services by 2012.
3.16. Support
prevention with positive workshops and meetings
The programme
aims at partnering with HIV positive people to prevent the transmission of the
epidemic in the community. The programme will propose to train these people on
the methodologies for community mobilization in the fight against HIV/AIDS. The
programme proposes to organize and conduct workshops for people living positively
with HIV/AIDS. The following key topics/themes will be focused on in the
workshops:-
·
Community
socio-cultural dynamics and HIV/AIDS transmission.
·
Stigmatization
and discrimination.
·
Diseases
of stigmatization and discrimination.
·
Role
of family and community in the fight against HIV/AIDS stigmatization and
discrimination.
·
Concepts
of community mobilization.
·
Role
of people living positively with HIV/AIDS in the fight against the pandemic.
·
Development
of action plan.
A total of
120 participants will be targeted in three workshops within the time period of
the programme. Follow-up meetings will also be conducted on quarterly basis for
a period of 3 years.
4.0.
REPRODUCTIVE HEALTH CARE SERVICES STRENGTHENED
4.1. Support
male and female condom education and distribution
Male and
female condoms are inaccessible to the pastoralist in the rangelands, and
therefore they are at risks of STI/HIV/AIDS transmission. The programme
aims at disseminating condom use messages in all workshops conducted within the
programme period as well as facilitating distribution to rangelands. The
programme will target to distribute 2000 male condoms and at least 200 female
condoms. Condoms will be supplied by ministry of public Health
and sanitation (MOPHS) to the programme in order to facilitate distribution to the
community.
4.2.
Support supply of contraceptives
Contraceptive
services are inaccessible to mobile pastoralist in the rangelands, and
therefore artificial family planning is never practiced by the pastoralist in
the rangeland. The programme will mobilize contraceptive products from the
ministry of public health and sanitation, and facilitate accessibility through
programme out reach health services strategy to the pastoralist communities in
the catchment area. A total of 60 clients will be targeted by the programme by
the end of 2012.
4.3. Support
screening of sexually transmitted infections, treatment and
referrals
Sexually
transmitted infection services are never accessible to the pastoralist in the
rangeland except for pastoralist at satellite centres where health facilities
are located. The programme will be to access these services to the
pastoralist at the rangeland through mobile / outreach health service project.
Awareness message will also be disseminated in all workshops conducted by
the programme on STI /HIV /AIDS transmission and prevention measures. A
total of at least 80 patients will be targeted within 3 years time.
4.4. Support
delivery of antenatal package
This
activity aims at mobilizing resources from the ministry of public health and
sanitation in order to promote maternal health at the rangelands. The programme
will facilitate delivery of maternal health care services through mobile /
outreach heath service project. A total of 50 mothers will be targeted for
antenatal package.
4.5.
Support community-based reproductive health awareness workshops.
Pastoralist
communities are unaware of their reproductive Health rights and services. The
aim of the programme will be to create and build awareness on reproductive
health rights and existing services.
Community-based
reproductive health care workshops will be conducted targeting the following
beneficiaries:-
·
Community
leadership.
·
Community
health workers.
·
Community-based
distributors.
·
Women
of reproductive Age.
·
Adolescents
and youth.
·
Men (male
involvement in reproductive health care).
The key
themes of the workshops will be as follows:-
·
Community
reproductive health needs.
·
Reproductive
health rights.
·
Community
resource mobilization for reproductive Health e.g. community-based transport
system.
·
Community
participation for reproductive health care.
·
Community
linkages with reproductive health providers.
·
Role
of family and community in reproductive health care.
·
Male
involvement in reproductive health services.
A total of three workshops will be conducted per year
for a period of two years targeting 180 participants.
4.6. Support integration of family
planning and reproductive health into HIV testing and counseling.
The
programme will aim at screening family planning clients for sexually
transmitted infections and HIV/AIDS in cases of unknown status. HIV testing and
counseling will be a routine activity to be conducted for family planning and
STI patients/clients. The programme will also use partner notification strategy
when providing STI services to the community. Partner management is an
effective way of detecting untreated STI’S and undiagnosed HIV infections (e.g.
discordant couples). This strategy is important since association of HIV and
STI has been documented in practice ( e.g. vaginitis, urethritis genital ulcer
diseases, a Herpes simplex virus type 2). The programme will aim at targeting
40 family planning clients and 50 STI’S patients within a period of 3 years.
5.0.
MATERNAL HEALTH CARE SERVICE IMPROVED
5.1. Support
delivery of focused antenatal care package to pregnant mothers
The aim of this
activity is to provide a package of care to pregnant mothers in the rangelands
among the pastoralist community. Focused antenatal care (FANC) will focus on
the following:-
·
Intermittent
preventive treatment e.g. malaria in pregnancy.
·
Prevention
of mother to child transmission ( PMTCT).
·
Tuberculosis
screening and referral in pregnancy.
·
Enhancing
linkages within the existing structures in provision of comprehensive focused
Antenatal care.
·
Community
role in promotion of care seeking behaviour.
A total of 120 pregnant mothers will be
targeted in 3 years.
5.1.1. Conduct
focused antenatal care package community workshops
Pastoralist
foundation for life focuses to facilitate community transformation towards
promotion of maternal health care at households and community level. This is to
reduce maternal and neonatal morbidity and mortality at the household and
community levels. The programme will use outreach strategies to reach the
target pastoralist community. Community based workshops will be conducted at
the village level focusing on the following topics:-
·
Focused
Antenatal care.
·
Individual
birth plan.
·
Danger
signs in pregnant, labour and delivery.
·
Emergency
preparedness for pregnant mothers.
·
Malaria
in pregnancy.
·
TB in
pregnancy.
·
Prevention
of mother to child transmission.
·
Anaemia
in pregnancy.
·
STI/HIV
in pregnancy
·
Prevention
of postpartum haemorrhage.
·
Role
of community in promotion of health care seeking behaviour.
·
Immunization.
·
Role
of fathers (men) in focused Antenatal care ( FANC.)
The
workshops will target the following:-
- Pregnant
mothers and their husbands.
- Breastfeeding
mothers and their husbands.
- Adolescent
girls and boys.
The
programme aims at facilitating three workshops targeting a total of 90
participants within a period of 3 years.
5.1.2.
Support supply of essential drugs for focused antenatal care package
Essential
drugs and medical supplies is an essential part in a health service delivery
system, and therefore the programme will propose supply of drugs in order to
facilitate service delivery at the community in the rangelands. The programme
team will aim at mobilizing drugs and medical supplies from ministry of public
health and sanitation for service delivery at the outreach service delivery
points in the community. The programme will focus to reach at least 50
Antenatal mothers in 3 years.
5.2.
Support skilled birth attendance community campaigns
This
activity is aimed at conscientisation of the pastoralist community on the
importance of skilled birth attendance strategy in prevention of maternal
mortality e.g. postpartum hemorrhage, which is a leading cause of maternal
mortality in Africa e.g.
5.3.
Support monitoring of pregnancies at outreach services
This
activity aims at monitoring maternal and fetal well-being throughout the
gestation period by focusing on the following during each outreach visit to all
pregnant mothers:-
- Blood
pressure assessment of the mother.
- Fetal
movement and fetal heart rate.
- Assessment
of maternal vital signs.
- Assessment
of general health of the mother e.g. malaria, TB, Anaemia and
STI/HIV/AIDS.
- Maternal
nutritional assessment.
The programmes
focus at targeting 50 mothers by 2012.
5.4.
Support vitamin a supplementation for lactating mothers
Vitamin A
supplementation is a national strategy aimed at promoting child survival by
acquiring vitamin A through maternal breast milk, vitamin A helps to prevent
against common childhood diseases. This activity aims at targeting at least 100
lactating mothers for vitamin A supplementation in 3 years period.
5.5. Support
nutritional supplementation for vulnerable pregnant and lactating
mothers
Nutrition
is vital for fetal growth and well-being in the uterus as well as healthy development
in future. Adequate quantities of essential amino acids derived from proteins
are essential for development of organs during the period of organ formation in
fetus. Amino acids are the building blocks of brain cells and the entire
nervous system of a developing fetus in utero. This determines the child future
performance in adulthood. The programme aims at facilitating provision of food
to vulnerable pregnant and lactating mothers in order to promote maternal and
child well –being, and consequently reduce morbidity. The programme aims at targeting 100 mothers
to benefit from the project in 3 years.
5.6. Support supply of essential drugs for
medical treatment in pregnancy and
childbirth
The
programme aims at facilitating the supply of essential drugs for management of
medical conditions in pregnancy and childbirth; this is in order to reduce
maternal morbidity and mortality. A total of 100 pregnant and postnatal mothers
will be focused by the programme through mobile health care services.
6.0.
CHILD HEALTH CARE SERVICES IMPROVED
6.1.1. Conduct community integrated management of
childhood illness workshops
Integrated
management of childhood illnesses is a WHO strategy adapted globally and aimed
at reducing childhood morbidity and mortality, particularly in developing
countries. Pastoralist foundation for life integrated outreach health care
services programme aims also at implementing I.M.C.I strategy at household and
community level among the pastoralist community. Community I.M.C.I strategy
aims at strengthening household-based preventive strategies in order to reduce
health hazards at the child’s environment, and therefore reduce child
morbidity. The programme aims to conduct
workshops focusing on the following key areas:-
·
Breastfeeding.
·
Supplementary
feeding.
·
Provision
of micronutrients e.g. vitamins.
·
Immunization
and main symptoms in I.M.C.I.
·
Malaria
prevention and management.
·
Promotion
of child mental and social development.
·
Feeding
of sick children.
·
Vaccination
of pregnant mothers with tetanus toxoid vaccine. Safe disposal of stool and
hand washing with soap and water.
·
Preventive
measures against HIV/AIDS.
·
Prevention
of child abuse.
·
Reproductive
health.
·
Prevent
and treat child injuries.
The above
are household and community practices for I.M.C.I which the programme aims at
strengthening implementation at pastoralist households. The programme is aiming
at conducting two workshops, targeting 120 participants in a 3 year period. The
programme will target the following beneficiaries:-
- Pregnant
mothers.
- Breastfeeding
mothers.
- Adolescents
and youth.
- Men (e.g.
male involvement in I.M.C.I.)
6.2. Conduct
mobile immunization services
Expanded
programme on immunization services are inaccessible to the pastoralist
community. Out reach /mobile services strategy becomes the only realistic means
of accessing vaccination to children and pregnant mothers. Immunization as one
of the global strategy for reducing child morbidity and mortality, will be a
key strategy for promoting pastoralist child survival. Resources input for the
activity will be from MOPHS. The programme aims at targeting 500 children and
pregnant mothers in 3 years time.
6.3 Support
nutritional supplementation for children with acute malnutrition
(I.M.A.M)
Worldwide,
malnutrition is one of the leading causes of morbidity and mortality in
childhood. Severe malnutrition in infant is common in developing countries.
Food deficiency characteristics displayed by the pastoralist communities
includes the following:-
·
Insufficient
food at household.
·
Inadequate
knowledge of feeding technique.
·
Improper
feeding habits.
·
Poor
hygiene
These
factors exposes pastoralist child to malnutrition. Drought is also a prevalent
factor in pastoralist occupied regions. This is also characterized by household
food deficiency, and therefore childhood malnutrition with immunodeficiency
result into pneumonia and diarrhea diseases. The programme aim will be to
integrate management of acute malnutrition with programme activities. A total
of 120 children will be targeted within a period of 3 years
6.4. Support
supply of essential drugs for integrated management of
childhood illnesses (IMCI)
Shortages
of essential drugs at health facility level is a common feature in pastoralist
areas due to unreliable drugs supply logistic system .Frequent shortage of
essential drugs and inaccessibility of health services contribute to childhood
mortality. The programme will propose supply of essential drugs for I.M.C.I activities at the outreach
services. I.M.C.I activities
will target to provide care to 200 children by the end of 2012.
6.5. Support
school health programme services
These activity aims at promoting child health
in the pastoralist areas, .The programme will provide the following health
services
-
screening
for minor illnesses and proving treatment
-
Physical
examination for disorders.
-
Assessing
immunization status
-
Revaccination
for B.C.G vaccine and tetanus toxoid vaccine for those with wounds.
-
Referral
for children with major disorders to health facilities
-
Deworming
and vitamin A supplementation
-
Voluntary
counseling and testing.
-
Health
education and work place H I V counseling and testing
The
programme will target Nursery, Primary and, Secondary school in the catchment
area. It will target at least 20 schools with a total population of 500
beneficiaries.
3.8 ACTION PLANS AND
BUDGET
The
detailed action plans indicating milestones, the places where the
interventions/services will take place and the resource requirements together
with the budget are given in Table 1.
Specific
details on implementation of each results or activities is described above
under results and activities.