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 Republic of Ethiopia in the North, Wajir North in the East and Moyale, Marsabit to the West and Isiolo District to the South. (See Appendix 6).  The major pastoralist groups inhabiting the District are Borana, Gabra, Ajuran and Gari.

 

a) KENYA

Kenya is a large country situated in East Africa with a size of 582,646sqkm.  In 2009 the estimated population was 40Million people.  Three sectors provide employment opportunities for Kenyans, Agriculture (80%) Service Sector (13%) and Industry (7%).  Kenya is in the top 30 of largest recipients of bilateral and multilateral aid 457 Million US Dollar and Foreign debt is 64.7% of the Gross Domestic Product (The Economist 1999).

 

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 Eastern Province bordering to the North the Republic of Ethiopia.  The District is divided into four administrative divisions Obbu, Uran, Dambalafachana and Walda.  The population is 15,440 with 3,789 households as shown in table 1 below – 62.02% of the population is estimated to be living in poverty.  The District is classified as Arid and Semi arid with Savanna type of vegetation.  Rainfall ranges from 360mm to 800mm per annum.  There are no permanent rivers, and the main sources of water are open pans, surface run offs, shallow water wells and boreholes.

 

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: Moyale District Hospital Health Statistics, year 2009.

 

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 Kenya

 

MISSION

To facilitate the provision of quality Health promotion and basic social services to the marginalized pastoralists communities in Sololo District in Kenya

 

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 Kenya.

 

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.

 

Sale of firewood and charcoal burning to generate household income is common. This destroys the vegetation and creates desertification in Arid lands. Destruction of vegetation facilitates soil erosion with loss of soil fertility, resulting in poor crop production. Loss of vegetation covers due to overgrazing and charcoal burning causes flood with destruction of community physical assets and human life. Harsh climatic condition in Arid and Semi arid land inhibit crop production in large scale. Pastoralist consumes milk and raw blood from domestic animals. They acquire zoonotic diseases. e g  .bovine tuberculosis and brucellosis.

 

 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: Sololo Mission Hospital enhancing community participation in health services programme baseline survey, March 2009

 

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

  1. Malaria.
  2. Joint pains.
  3. Skin infections.
  4. Diarrhoea.
  5. Worms and parasites.

2.Mado Adhi.

  1. Diarrhoea.
  2. Malaria.
  3. Acute respiratory infections.
  4. Joint pains.
  5. Eyes infections.

3.Dadach Elele.

  1. Malaria.
  2. Diarrhoea.
  3. Acute respiratory infections.
  4. Joint pains.
  5. Skin infection.

4. Rawana

  1. Malaria .
  2. Diarrhoea.
  3. Eye infections.
  4. Ear infections.
  5. Common cold.

Source: Sololo Mission Hospital enhancing community participation in health services programme baseline survey, March 2009

 

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 Kenya, may 2008.

·        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 Africa.

 

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 KENYA NATIONAL AIDS STRATEGIC PLAN ( 2005-2010).

 

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 Kenya, especially in young children and pregnant women. 20% of death in children under 5 years is due to malaria. The ministry of Health have prioritized malaria control and developed the National malaria strategy ( NMS), 2001-2010 and National health sector strategic plan II ( 2005-2010) laying emphasis on scaling up implementation of effective intervention. One of the key strategy interventions of the National malaria strategy is to provide prompt and effective treatment of malaria. The global malaria control strategy ( GMCS) advocates four technical measures .( WHO Guidelines).

·        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 KENYA,

       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 Kenya government, with support from various partners to increase knowledge of HIV sero-status among all Kenyan citizens. This is towards achieving ‘’ Universal access’’ to HIV testing and counseling services through the scale-up of voluntary counseling and testing ( VCT) and provider initiated testing and counseling ( P.I.T.C.). It is in order to reach ‘’ Universal access’’ goal of 80% of Kenyans knowing their HIV status by the year 2010.

 

The national guidelines for HIV testing and counseling in Kenya introduced new approaches to HIV testing and counseling that will reduce the number of missed opportunities for providing HIV testing and counseling services.

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 Kenya as, poverty, socio- economic deprivation and concurrent HIV pandemic. In order to address the new challenges posed by the tuberculosis epidemic in the face of the HIV epidemic and socio-economic deprivation, the ministry of health through the national leprosy and Tuberculosis programme ( NLTP) identified the following areas for increased support:-

·        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 Kenya.

 

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, Kenya. This strategy aims at reducing childhood morbidity and mortality, particularly in developing countries e. g Kenya.

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 INTERGRATED HEALTH CARE SERVICES PROJECT

 

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 Kenya, pastoralists occupy a larger share of the area.  In 2009 the projection showed that out of the total Kenyan population of 40Million, 5.8 Million (14.5% of the total population).  People could be categorized as pastoralists.  Common denominators for pastoralists are:-

·        Pastoralists have limited access to basic services – education, Health, water and sanitation facilities, compared to other inhabitants in Kenya.

·        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 Kenya is estimated at 414 per 100,000 (KDHS 2003).  88% of pregnant women attend antenatal clinic and only 41% of mothers are assisted by a skilled birth attendant during delivery.  The declining number of deliveries conducted by skilled providers against an increasing number of home deliveries has caused maternal mortality to increase.  Home deliveries are common among the pastoralists.  Tuberculosis is one of the leading infections causes of death among women of reproductive age.  Notified cases have increased by 10 fold over the last 15 years.  Malaria is one of the top development concerns for Kenya as 70% (20million) of the total population is at risk of infection.  It is a major cause of maternal and neonatal mortality and morbidity.

 

In the Kenya demographic health survey of 1998 and 2003 there was a 30% increase in mortality in the less than five age groups in the five years preceding each of these surveys.  This increase in mortality is largely attributable to HIV either directly or indirectly through maternal morbidity and mortality.

 

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 Kenya.

 

About 70 children die from diarrhea and related illnesses in Kenya every day.  According to the 2008/2009 demographic and health survey, diarrhea prevalence increased from 16% in 2003 to 17% in 2008. Source: Daily Nation Newspaper, 1st April 2010

 

The leading causes of morbidity and mortality in Kenya are related to maternal and perinatal causes, HIV/AIDS and related opportunistic diseases, malaria and injuries.  Diseases like diarrhea, pneumonia, measles, malaria and protein caloric malnutrition account for more than 70% of the deaths among the under five age group.

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 Kenya and organizations in Pastoral areas.  Due to inaccessibility of the areas many government of Kenya facilities are under utilized or non functional.

 

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.

 

  • Counseled

3,244

  • Tested

3,244

  • Positive

     53

  • Tested for syphilis

 1849

  • Positive

       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 Africa’s poor, Tuberculosis, Malaria and HIV/Aids are prevalent within the poor population of pastoralists in Sololo District. 

 

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 Kenya.  Making pastoralists to die from preventable deaths.  Prevalent of these diseases in population denies development of human potentiality in developing nations eg pastoralists of Sololo District, in Kenya.

 

To break the stigma of silence, pastoralists foundation for life advocates that time has reached to address Health needs of the Pastoralist through MOBILE  INTEGRATED HEALTH CARE SERVICES PROJECT,”. This is in order to close the gaps in Health Access

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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 Kenya

Staffed and operational

Anona

1351

Dispensary

Government of Kenya

No staff not operational

Sololo Township

5181

Hospital

Diocese of Marsabit

Operational

Waye – Godha

556

Dispensary

Government of Kenya

No staff not operational

Mado - Adhi

934

dispensary

Government of Kenya

Not staffed, not operational

Sololo Makutano

1233

dispensary

Government of Kenya

Not staffed not operational

Dambala Fachana

Dambala Fachana

1577

Dispensary

Government of Kenya

Staffed  operational

Ambalo

1276

Dispensary

Government of Kenya

Not staffed Not operational

Garba

750

No Health Facility

-

-

Uran

Golole

1727

Dispensary

Government of Kenya

Not staffed not operational

Karbururi

693

No health facility

-

-

Uran

1255

Dispensary

Government of Kenya

Operational staffed

Uran Lataka

978

No Health facility

-

-

Banale

85

No health- Facility

-

-

Walda

Walda

1276

Dispensary

Government of Kenya

Not Operational

Rawana

312

No health facility

-

-

 

Source: Moyale District Hospital Health statistics, year 2010

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 KenyaEthiopia border.  Other tribes living in these Districts also have access to the health services provided. Within the general target group, mobile integrated project puts emphasis on targeting the following groups; Adults, pregnant mothers, lactating mothers, infants and children, youth and adolescents, family planning clients, couples, patients with STI and TB and people with disabilities. The project targets women and children mostly because of their risk to ill health. Women due to their reproductive role are predispose to many health related problems and therefore need more health care attention. Children on the other hand need more support since they are growing, a category requiring energy and other nutrition and protective care, to develop immunity and be able to cope with life demands.

 

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 Kenya. 

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 Kenya.

 

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 Kenya, with 50% of married or cohabitating HIV infected persons having on HIV negative spouse (KDHS, 2003). The programme aims at conducting couples HIV testing and counseling at their homes. This is aimed at reducing HIV transmission risk within discordant couples, facilitating disclosure, referrals and to provide social support. The programme aims at building and strengthening community or home-based HIV testing and counseling strategy among the pastoralist rangeland in order to reduce HIV transmission The programme will target at least 200 couples by the end of the programme period.

 

 

 

 

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 Kenya, may 2008. Youth-out of school are expected to play a key role in community HIV/AIDS activism and be at the frontline in the fight against HIV/AIDS and advocate for community behaviour change.

 

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. Mobile / outreach services will integrate PMTCT activity in order to facilitate accessibility of PMTCT services to the community. This is to target women within the reproductive age bracket so that they can be screened for HIV infection. The programme proposes to target 250 pregnant and postnatal mothers within the programme period of 3 years.

 

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 Kenya as 70% ( 20 million) of the total population is at risk of infection. It is a major cause of maternal and neonatal mortality and morbidity. The programme aims at facilitating administration of SP to pregnant women during mobile/ outreach integrated services.

 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. Kenya. The programme aims at conducting community public meetings for awareness on the benefits skilled birth attendance, targeting at least 2000-5000 participants in 3 years.

 

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 essent