PASTORALIST
FOUNDATION FOR LIFE
SOLOLO
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 needy assessment survey carried out by
Pastoralist Foundation for Life on 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 form the backbone
pastoralist food security system. Diseases, drought and cattle rustling
seriously affect Livestock Production System. Livestock losses due to drought
creates households economic damage and poverty, facilitating pastoralist
dropout from pastoralist lifestyle to street dwellers in satellite centres and
major towns in
Drought crisis resulting from rainfall shortage
break down 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 of struggling to meet basic needs in major towns, the pastoralists
acquire 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 fire arms. These fire arms are used for cattle rustling
to facilitate self-restocking after drought or diseases outbreaks causing
massive livestock losses and households poverty. Limited markets for livestock
and their products make pastoralist economic base very fragile and unstable.
Pastoralists have limited knowledge on
utilization of natural resources potential, e.g. land, water sources, wildlife
for eco-tourism, sand, gravels, vegetation for commercial purpose e.g. timber.
These resources are exploited by the few rich people who claim to be assisting
pastoralist to solve their problems.
High pastoralist rural-urban migration during
drought, cattle rustling and tribal conflicts create poverty and development of
slums in satellite centres, street children are becoming a major problem to
most pastoralist shopping centres. This is also accompanied by young girls
prostitution to ???
??? household food insecurity regardless of
seasons, facilitating brewing of changaa in villages.
This builds up a culture of alcoholism in
villages and waste of economic resources due to negligence of livestock
rearing.
Heavy relief food delivery during drought
spells with prolonged distribution of relief food creates 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 a serious shortage of
animal milk.
Lack of essential nutrients leads to
immunodeficiency of the general population during drought and famine,
triggering outbreak of pneumonia, diarrhoeal 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 pastoralists do not practice crop farming because they live in arid
and semi arid areas.
Pastoralists purchase food stuff in shopping
centres during food shortages i.e. drought and famine. These food stuffs are
sold at high prices and pastoralists are exploited in the process.
Harsh climatic condition in arid and semi-arid
lands inhibit crop production in large scale.
Pastoralists consume milk and raw blood from
domestic animals. They acquire zooinotic diseases e.g. bovine tuberculosis and
brucellosis.
B - Reproductive
Health Needs in Pastoralism
Male domination in Reproductive Health decision
making is central in pastoralism. Husbands decide for delivery facility and
antenatal attendance. Male also decide how the 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 conditions, predisposing to puerperal and neonatal sepsis.
Limited accessibility of family planning
services in pastoralist communities leading to large family sizes. High risk
pregnancies are also prevalent due to lack of family planning information and
services.
Early child marriages - this subjects young
girls to obstetric complications during delivery because their reproductive
system is immature to withstand the physiological stress of pregnancy and
labour. Obstructed labour becomes prevalent in young women and vesico-vaginal
or recto-vaginal fistulae complication are very distressing experiences to
young women and this subjects them to divorce.
Negative socio-cultural belief of the pastoralist
community on reproductive health services.
Perception of children as a sign of wealth in
pastoralist society. Women are seen as producers of children. This subjects
them to multi-parity and high risk obstetric categories. High risk obstetric
category causes maternal mortality.
Lack of ownership of economic resources for
women hindering the ability to meet cost for reproduction health care services.
Discrimination of girl-child in education with
future negative impact in adult life decision making.
Poor delivery health services and systems in
pastoralist community, limiting utilization of reproductive health services.
Pastoralists lack knowledge on existence of
reproductive health services.
Female genital mutilation practices. This is
complicated with haemorrhage, sepsis, scaring, obstructed labour and
vesico-vaginal fistulae.
Migratory lifestyle of pastoralists limiting
accessibility and delivery of reproductive health services.
Wife inheritage, 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.
Pastoralists entirely rely on natural water sources and individually developed
by a clan or a recognized individual. Water system is managed by elder who
direct the community on the 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 the main community water point.
Pastoralists belief that water is a 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 important in the life
of pastoralists, because it determines their settlements, ceremonial activities
and utilization of pasture from the rangelands. Water points in pastoralism
lifestyle can be a source of human and animals conflict as well as human to
human conflict with loss of life and property.
Pastoralists main water points include hand dug
wells, earth dams, surface run off, natural springs and natural sand dams in
river beds. These water sources are subject to contamination from organic
wastes and disease producing organisms, making diarrhoeal diseases as the most
prevalent morbidity in pastoralists’ areas. Pastoralists do not belief on
boiling of water since they belief that water cannot transmit diseases.
Water points in most pastoralist communities
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 services in pastoralist occupied
districts are inadequately delivered, limiting socio-economic development of
the community.
Water supply is poorly developed in pastoralist
occupied rangelands. Pastoralists are almost always mobile in search for water
and pasture, facilitation transmission of communicable diseases in humans and
livestock.
Most water development projects established in
pastoralist areas are not people centred and lack community involvement. People
lack sense of ownership of projects resulting into non-sustainability of
projects and persisting community water needs.
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 e.g. vegetation and depletion of
natural resources.
Human consumption of contaminated water results
into their suffering from waterborne diseases e.g. cholera, typhoid and amoebic
dysentery .
Stagnant water from surface runoff dams, are a
favourable media for breeding of mosquito larvae.
Malaria is usually a threat to pastoralist
community during rain seasons. Pastoralists 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 pastoralists move long distances
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.
Pastoralists 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
pastoralists 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
- Breakdown 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
- Decreases pastoralist life expectancy and
child survival
- Increases school drop-outs especially for the
pastoralist girl-child
- Creates grandparents/children headed
households/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 mal-absorption
- 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 opportunistic infections
within the families and pastoralist communities e.g. tuberculosis.
Needs assessment study also tried to find out
marginalised minority groups in pastoralism and the challenges they face in the
community in meeting their health and development needs. This is shown in Table
I below:
Table I: Marginalised
Minority Groups in Pastoralists and challenges they face meeting their health
and development needs
|
|
Marginalised
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 STD/HIV/AIDS |
|
|
|
- unmet reproductive health needs |
|
|
|
- lack of money to pay health care services |
|
|
|
- migration to towns outside their community |
|
2 |
Divorced Women |
- no rights to inherit resources and wealth |
|
|
|
- poverty |
|
|
|
- social rejection |
|
|
|
- possibility of promiscuity |
|
|
|
- lack of money to pay for basic needs |
|
|
|
- unmet reproductive health needs |
|
|
|
- migration to towns outside their
communities |
|
|
|
- psycho social 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 |
|
|
Marginalised
Minority Group |
Health and
Development challenges faced |
|
3 |
Disabled Persons |
- not able to meet their basic needs e.g.
blind and physically challenged |
|
|
|
- lack of employment |
|
|
|
- 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
e.g. hygiene, accessibility to essential medicines |
|
4 |
Orphans |
- lack of essential basic needs |
|
|
|
- lack of parental love and care in
upbringing |
|
|
|
- risk of acquiring diseases of poor
sanitation e.g. diarrhoeal diseases |
|
|
|
- poor housing conditions |
|
|
|
- lack of basic education |
|
|
|
- food shortages, especially during drought
and famine, leading to malnutrition |
|
|
|
- lack of psycho social stimulation as a
result 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
e.g. food, health care, education, shelter |
|
|
|
- poverty at households, leading to
malnutrition |
|
|
|
- inadequate parental love and care for 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 |
|
|
|
- risk of contracting communicable diseases
e.g. tuberculosis and other co-infections e.g. malaria |
|
|
|
- periodic shortages of ARV’s and
opportunistic diseases medications |
|
|
|
- community discrimination and stigmatisation |
|
|
|
- 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 |
|
|
Marginalised Minority
Group |
Health and
Development challenges faced |
|
8 |
Female Headed Families |
- due to lack of wealth inheritance for
women, poverty of households results |
|
|
|
- this is associated with diseases of poverty
e.g. tuberculosis and malnutrition |
|
|
|
- poor housing with transmission of air-borne
diseases |
|
|
|
- lack of essential basic needs e.g. 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 STD/HIV/AIDS as a result of
multiple sexual partners |
|
9 |
Pregnant and lactating mothers |
- anaemia related to iron and folic
deficiency, threatening the life of the mother and foetus |
|
|
|
- at risk of pregnancy and delivery related
complications e.g. APH, PPH and sepsis |
|
|
|
- poor transportation systems in pastoral
areas to facilitate referrals in cases of emergencies |
|
|
|
- maternal malnutrition in times of household
food deficits e.g. in drought and famine, leading to foetal intrauterine
malnutrition |
|
|
|
- malaria in pregnancy threatening maternal
and foetal well-being |
|
|
|
- at risk of transmitting HIV/AIDS to
newborn/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 e.g. TB and malaria |
|
|
|
- increased physiological demands in
pregnancy and lactation causing nutritional deficiency disorders |
|
10 |
Children under 5 years |
- biological pathogens and their
vectors/reservoirs e.g. micro-organisms in human excreta, disease vector e.g.
mosquitoes, houseflies, rats and airborne pathogens |
|
|
|
- inadequate quantity of natural resources
e.g. food, water |
|
|
|
- physical hazards - within the house e.g.
domestic injuries and outside e.g. flooding |
|
|
|
- poor services and security |
|
|
|
- poor immunisation services |
Source:
The Needs Assessment Baseline Survey also
revealed disease priorities by communities visited as shown in the Table II
below:
Table II: 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. Worm and Parasites |
|
2 |
Mado-Adhi |
1. Diarrhoea |
|
|
|
2. Malaria |
|
|
|
3. Acute respiratory infections |
|
|
|
4. Joint pains |
|
|
|
5. Eye infections |
|
3 |
Dadach-Elele |
1. Malaria |
|
|
|
2. Diarrhoea |
|
|
|
3. Acute respiratory infections |
|
|
|
4. Joint pains |
|
|
|
5. Skin infections |
|
4 |
Rawana |
1. Malaria |
|
|
|
2. Diarrhoea |
|
|
|
3. Eye infections |
|
|
|
4. Ear infections |
|
|
|
5. Common cold |
Source:
Malaria and diarrhoea are the two top causes of
morbidity as ranked by the communities. These diseases are environmental and
sanitation related morbidities.
Endemic diseases in the general population
assessment was also done and the community prioritised the following diseases
- Anaemia
- Tuberculosis
- 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.
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 (PMTCT)
- National Health Sector Strategic Plan II,
2005 - 2010
- National AIDS Strategic Plan, 2005 - 2010
- National Guidelines for Diagnosis, Treatment
and Prevention of Malaria
- National Guidelines for HIV Testing and Counselling
in
- National Guidelines for Quality Obstetrics
and Prenatal Care
- National Tuberculosis and HIV Collaborative
Activities Guidelines
- National Guidelines on Integrated Management
of Childhood Illness (IMCI)
- WHO Guidelines on the use of insecticide -
treated mosquito nets for the prevention and control of
malaria in
The above documents were referenced during the
development of the project proposal and they form key component in directing
project implementation.
A) National Guidelines
for Prevention of Mother to Child Transmission of HIV/AIDS (PMTCT)
HIV infection in infants are most often the
result of Mother-to-Child transmission during pregnancy, labour and delivery or
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 Plan II (2005 - 2010)
The National Health Sector Strategic Plan II
preparation mainly borrowed from the National Health Sector Strategic Plan
(1999 - 2004) and 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 level.
C) The
This document form the basis of all HIV
prevention and car programmes, including HIV testing and counselling prevention
of Mother-to-Child transmission of HIV/AIDS, sexually transmitted infections
and HIV/AIDS, blood transfusion safety, quality assurance for voluntary,
counselling and testing and diagnostic testing and counselling.
D) National Guidelines
for Diagnosis, Treatment and Prevention of Malaria
Malaria remains a leading cause of morbidity
and mortality in
One of the key strategic 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) National Guidelines
for HIV Testing and Counselling in
HIV testing and counselling 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
This is towards achieving “Universal Access” to
the HIV testing and counselling services through the scale-up of voluntary
counselling and testing (VCT) and Provider Initiated Testing and Counselling
(PITC). 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 counselling
in
These approaches are:
- door to door testing of HIV
- self - testing
- HIV testing in work place, clients and
patients home
- couples and family testing
- outreach HIV testing and counselling e.g. use
of vehicle with private counselling rooms, tents as counselling 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 counselling
- 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
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:
- decentralisation 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 coupled with health care worker training
and support to promote early 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 Prenatal Care
This guideline emphasize 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.
°
Malaria in pregnancy
°
Prevention of mother to child transmission
° Tuberculosis
- FANC is the 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 haemorrhage. This
guideline focuses on reducing maternal mortality in
H) National Guidelines
on Integrated Management of Childhood Illness (IMCI)
IMCI is a global strategy developed by World
Health Organisation’s Division of child health and development and UNICEF and
adapted by the Division of Child Health, Ministry of Health,
- 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
IMCI is a key strategy in meeting millennium
development, goal of reducing childhood mortality. Non of the above national
health documents is in line with pastoralists’ health needs.
HISTORY OF PASTORALIST
FOUNDATION FOR LIFE
Mobile Dispensary Health Care Services Project
started in form of outreach curative care services on
The outreach curative care services programme
initiative was through the efforts of Doctor
Pino Bollini, who felt that mobile pastoralist health care services are
unmet. The aim of the programme was to make health services accessible to
mobile pastoralist, since health service delivery is centralised at the
district head quarters and satellite centres.
The programme was receiving funding from
Collaboration of Medical Doctors - Italy (CCM) through the leadership of Doctor
Pino Bollini 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 Dispensary
Health Care Services Project. Since these staff were members of a community
based organisation (CBO) “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.
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
Committees i.e. 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
community in the catchments areas facilitating reduction of outbreak of
diseases such as diarrhoea and cases of cerebral malaria
- increased self-preventability of disease,
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 minimise essential drug 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 I,
below:
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 characterised by outbreak of
diarrhoeal 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.
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 System are not tuned to meet
pastoralists health needs.
The killer diseases of
These diseases are threatening the life of
citizen 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 Programmes on these global life
threatening diseases do not focus on pastoralists as a special risk category
group in
Prevalent of these diseases in population
denies development of human potentiality in developing nations e.g.
pastoralists of Sololo District in
To break the stigma of silence, Pastoralists
Foundation for Life advocates that time has reached to address health needs of
the pastoralists through “Mobile Dispensary Integrated Health Care Services
Project”. This is in order to close the gaps in health access.
BENEFICIARIES AND
STAKEHOLDERS
a) Beneficiaries
The beneficiaries of mobile dispensary 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 Kenya-Ethiopia border. Other tribes
living in these districts also have access to the health services provided.
Within the general target group mobile
dispensary 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 marry 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
dispensary 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 EPI, curative care, health education and
STI/HIV/AIDS related services, Arid Land Resources Management, local or
international NGOs and UN Agencies such as AMREF, UNICEF, MEDS, REDCROSS, CCM,
local NGO and CBO such as FHI, CIFA, World Vision, CCS 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 various health services, Their
interests, strengths, weaknesses and possible areas of collaboration with
Pastoralist Foundation for Life Mobile Dispensary Project are also elaborated.
PROJECT INTERVENTIONS
1.0 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
2.0 Purpose
The project purpose is fivefold:
2.1
to reduce the spread of HIV infection in pastoralist in Sololo District in
2.2
to lessen the impact of HIV epidemic on pastoralist communities of Sololo
District
2.3
to improve referrals and linkages to comprehensive care, HIV prevention,
treatment and
social support
2.4
to improve family planning and HIV integrated services within the pastoralist
communities
of Sololo District
2.5
to reduce maternal and childhood morbidity and mortality in Sololo District in
3.0 Specific
Objectives
3.1
to promote community based HIV testing and counselling by conducting door to
door HIV
testing and counselling, HIV testing and counselling at homes of
patients on ART, couples
and their families testing and counselling, testing and counselling of
children of deceased or
HIV infected parents, providing initiated
testing and counselling, voluntary testing and
counselling and providing outreach HIV testing and counselling services
to mobile
communities
3.2
to promote prevention of mother to child transmission of HIV/AIDS by conducting
HIV
testing and counselling of pregnant and postnatal mothers, providing ART
and
cotrimoxazole prophylaxis, early infant diagnosis, referrals of DBs
specimen for HIV
exposed infants, facilitating partner testing and counselling,
conducting STI, TB and
anaemia screening, organizing infant feeding counselling workshops, SP
prophylaxis and
supporting infant feeding options for HIV exposed infants
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 PLWHAs’ groups, conducting adherence counselling, workshops, support
supply of ART
and opportunistic infections, drugs, conducting training and exchange
visits for PLWHAs,
supporting income generating projects for PLWHAs, nutritional
supplementation for
PLWHAs, supply of school materials and uniforms for orphans and
vulnerable children,
payment of school fees for orphans, payment of health care bills for
PLWHAs and
orphans, supporting trainings of treatment supporters, supporting
community-based
linkages for PLWHAs, support HIV/AIDS
support groups and supporting referrals of
PLWHAs for comprehensive care services
3.4
to strengthen reproductive health care services by facilitating distribution of
male and
female condoms, supporting supplies of contraceptives, screening of STI,
treatment and
referrals, delivery of antenatal care package, conducting reproductive
health community
awareness workshops, and supporting integration of family planning and
reproductive health
into HIV testing and counselling
3.5
to improve maternal health care services through delivery of focused antenatal
care package,
supporting skilled birth attendant campaigns, 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
3.6
to improve child health care services through supporting clinical and community
IMCI,
conducting mobile immunisation services, supporting nutritional
supplementation for
children with acute malnutrition, supporting supplementation supply of
essential drugs for
IMCI and supporting school programme services
STRATEGIES
1.0 Community-based HIV testing and counselling
promotion
2.0 Prevention of mother to child transmission
of HIV/AIDS promotion
3.0 Community care and support for people
living with HIV/AIDS and orphans improvement
4.0 Reproductive health care services
strengthening
5.0 Maternal health care services improvement
6.0 Child health care services improvement
STRATEGIES AND
ACTIVITIES
1.0 Strategy:
Community-based HIV testing and counselling promotion
Activities:
1.1 support door to door HIV testing and
counselling
1.2 support HIV testing and counselling at
homes of patients on antiretroviral therapy
1.3 support couples and their families testing
and counselling for HIV
1.4 support HIV testing and counselling for
children of deceased or HIV infected mothers
1.5 support outreach HIV testing and
counselling services
1.6 support youth out of school and
school-based HIV/AIDS programmes
1.7 support workplace HIV testing and
counselling
1.8 support community mobilization
1.9 support provider initiated testing and
counselling
1.10 support voluntary testing and counselling
2.0 Strategy:
Prevention of mother to child transmission of HIV/AIDS promotion
Activities:
2.1 support HIV testing and counselling for
pregnant and postnatal mothers
2.2 support ART prophylaxis for HIV positive
pregnant mothers and HIV exposed infants
2.3 support early infant HIV diagnosis
2.4 support referrals of DBs of HIV exposed
infants to national laboratories eg KEMRI
2.5 facilitate partner testing and counselling
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 infant early HIV diagnosis and
feeding counselling workshops
3.0 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 counselling workshops for
people living with HIV/AIDS and treatment
supporters
3.4 support supply of ART and opportunistic
infections drugs
3.5 conduct trainings 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 uniform 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/workshops
4.0 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 counselling
5.0 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
6.0 Strategy: Child
Health Care Services Improvement
Activities:
6.1 support clinical and community integrated
management of childhood illnesses (IMCI)
6.2 conduct mobile immunisation services
6.3 support nutritional supplementation for
children with acute malnutrition (IMAM)
6.4 support supply of essential drugs for IMCI
6.5 support school health programme services
EXPECTED
OUTPUTS/RESULTS
1.0 Community-based HIV testing and counselling
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
RESULTS AND ACTIVITIES
The programme director after consulting the
community, community organised groups and key stakeholders in the programme
catchments area identified six expected results/output 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)
The results and respective activities are as
follows:
1.0 Community-based
HIV testing and counselling promoted
1.1 Support door to door HIV testing
and counselling
Pastoralist Foundation for Life
Programme aims at accessing HIV services to pastoralists at their homes, this
is to facilitate prevention of the epidemic at the rangelands.
The programme will use
outreach/mobile strategy to reach the pastoral community for HIV testing and
counselling services.
The programme also aims at targeting
villages and households, using the door to door strategy for HIV testing and
counselling. The programme team will be camping at specific sites for service
delivery points in the programme catchments 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 counselling to 400 households (i.e. 2000 people) within a period of
3 years.
1.2 Support HIV testing and
counselling 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
counselling. This is to promote prevention, care and support at family unit
level.
Accessibility of HIV testing and
counselling for the pastoralist community in the rangeland is a dream, it is
never conducted and therefore pastoralist are neglected population in HIV/AIDS
epidemic.
The programme aims at targeting 200
households in the programme catchments area within the time scale of the
programme.
1.3 Support couples and their
families HIV testing and counselling
Prevalence of HIV discordance is
high in
The programme aims at conducting
couples HIV testing and counselling 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 counselling strategy
among the pastoralist in the 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
counselling 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 aimed at facilitating care, treatments and social support.
The programme will target at least
50 children in three years time.
1.5 Support outreach HIV testing and
counselling services
Pastoralist Foundation for Life
programme believes outreach/mobile integrated programme as the core strategy
for realising the programme goals and objectives. It is through this strategy
that the marginalised pastoralists at the rangeland will get access to HIV testing
and counselling services and receive linkage to care, treatment and social
support.
The programme propose to use the
following methodologies:
° mobile sites using tents
° market centres, targeting market
days
° pastoralist water points,
targeting herders
° pastoralist ceremonies days
° workplace, targeting schools in
ASAL regions
° patients’ homes
° clients’ homes
° immunization campaigns
° school games, i.e. during inter
schools competition
° outreach HIV testing and
counselling at night for pastoralist herders
The programme aims at implementing
the following outreach/mobile integrated activities/services
° home-based HIV testing and
counselling
° prevention of mother to child
transmission of HIV/AIDS
° provider initiated testing and
counselling (PITC)
° antenatal care package
° family planning services
° tuberculosis screening and
referrals
° STI screening and referrals
° opportunistic infections screening
and referral
° malaria prevention and control
° voluntary testing and counselling
° early infant diagnosis e.g. DBS
collection and referral
° ART, SP and cotrimoxazole
prophylaxis
° linkage to comprehensive care
clinic services
° school health programmes i.e.
school-based HIV/AIDS programme
° youth out of school programmes
° workplace testing and counselling
e.g. in school, kiosks
° community mobilization and health
education
The programme team will settle
within specific sites in the catchments area where the pastoral community can
access services for at least one to two weeks. The aim of the programme is to
target 6 mobile visits to the pastoral communities in the programme catchments
area per year for a period of 3 years i.e. 18 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 and alcoholism
- pressure of modern living
The programme purpose to facilitate
capacity building workshops at the rangelands targeting mobile pastoralists
youth. The key topics will be as follows:
- HIV/AIDS and youth in pastoralism
- benefits of HIV testing and
counselling 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 counselling at the end of every workshop. The programme
will strictly practice the core principles of HIV testing and counselling i.e.
consent, confidentiality and counselling, as per the national guidelines for
HIV testing and counselling in
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 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 grass root 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 organise 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
consciencize 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 marginalised pastoralist regions.
The programme propose to organise
and conduct 3 workshops, each to be attended by 40 participants, totalling to
120 participants in 3 years. The following topics are to be focused during the
workshops
- adolescent and HIV/AIDS pandemic
in pastoralism
- benefits of knowing one’s
HIV-Sero-Status
- impact of HIV/AIDS in education
sector and pastoralist lifestyle e.g. economy
- prevention, care, treatment and
social support for PLWHAs
HIV testing and counselling will be
part of the workshops as an integrated activity in the programme
1.6.3 Conduct training of
school-based counsellors on HIV testing and counselling
The programme aims at training 10
school-based counsellors for HIV testing and counselling. This is to establish
a community-based structure for fighters and building awareness on HIV/AIDS at
the pastoralist schools located in the rangeland areas i.e. those that are far
away from the satellite centres. These counsellors will be conducting HIV
testing and counselling in schools.
1.7 Support workplace HIV testing
and counselling
The programme aims at targeting
primary and secondary schools, kiosks in pastoralist satellite centres, CBOs
and other workplaces in the pastoralist region within the programme catchments
area.
This activity aims at accessing HIV
testing and counselling services to personnel at workplaces in marginalised
areas of the pastoralist community.
The programme also aims at
organising 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 counselling.
1.8 Support community mobilization
Community mobilisation 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 mobilisation
strategy, the programme will focus on the following:
- identify key people in the
community who can ultimately facilitate the dissemination of information
- aim to create a forum for
dialogue. Sensitisation 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 mobilisation
strategy.
- when dealing with community
influential figures, highlight the important of their participation in
programme activities.
The programme aims at organising and
conducting community leaders workshop, 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 KSh 4.000 per month.
1.9 Support provider initiated
testing and counselling
This activity 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
counselling 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 counselling
and testing
This activity promotes a situation
whereby an individual, couple or group actively seek out HIV testing and
counselling at the site of service delivery point i.e. at mobile sites or in
peoples’ homes.
This activity puts emphasis on risk
reduction counselling to help the clients or couples identify plans for the
prevention of HIV transmission or acquisition.
The programme will target at least
200 clients in three years.
2.0 Prevention of Mother to Child Transmission
of HIV/AIDS promoted
2.1 Support HIV testing and counselling
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
counselling and testing for HOV negative young women
° prevention of unintended
pregnancies in HIV infected women through voluntary family
planning
° universal HIV testing for pregnant
women
° ARU prophylaxis for HIV positive
mothers and exposed infants. Counselling and testing
for negative mothers and partners
° early infant HIV diagnosis
° prevention and treatment of
sexually transmitted infections
° provision of family planning
services e.g. post-partum-family planning
° referral to comprehensive care
clinic for follow-up
° male involvement for HIV
prevention, care and support
° infant feeding counselling e.g.
exclusive breastfeeding
° administration of highly active
anti-retroviral 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 the 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 service
to the community. This is to target women within the reproductive age bracket
so that they can be screened for HIV infection.
The programme propose to target 250
pregnant and postnatal mothers within the programme period of 3 years.
2.2 Support anti-retroviral 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 planned period.
2.3 Support early infant HIV
diagnosis
This 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 STIs who have young
children, unless they decline i.e. opt out
° diagnostic HIV antibody testing
and counselling 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 months
° HIV screening (antibody test) for
all infants of HIV-positive mothers and having unknown
status attending service delivery point, at 9 months and at 18 months
for confirmatory anti-
body 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 sport samples
specimen will be collected and referred to KEMRI by the end of the programme.
2.5 Facilitate partner testing and
counselling
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 Cotrimoxazole
prophylaxis for HIV positive persons
Cotrimoxazole prophylaxis for HIV
positive people provides protection against many opportunistic infections such
as
° bacterial
pneumonia
° malaria
° pneumocystis
pneumonia
° toxoplasmosis
° salmonella
Administration of cotrimoxazole 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
cotrimoxazole.
The programme will target to refer
at least 300 people within a period of 3 years.
2.7 Support Salfadoxine
Pyrimethamine (SP) Prophylaxis for pregnant mothers
Malaria is one of the top
development concerns for
The programme aims at facilitating
administration of SP to pregnant women during mobile/outreach integrated
services.
The programme propose 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 their quality of life and therefore preventing mortality
associated with malaria. Use of mosquito nets aims at avoiding man and vector
contact. The programme through mobile integrated services aims at distributing
400 insecticide-treated mosquito nets.
2.9 Conduct STI, TB, Malaria and
Anaemia Screening
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
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 referrals 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 counselling 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.
- exclusive breastfeeding
- replacement feeding e.g. AFASS
- complementary feeding
° nutritional counselling 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 analyse 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 organisation.
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 fights against
discrimination and stigmatisation 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 programme propose formation of
five groups of people living with HIV/AIDS
3.3 Conduct adherence counselling
workshops for people living with HIV/AIDS and treatment supporters
The programme aims at conducting
adherence counselling 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
° guardians 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
° causes of non-adherence
° 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
° Cotrimoxazole prophylaxis
° ART prophylaxis e.g. in
- pregnancy
- post-exposure prophylaxis
- rape victims
° Fluconazole-secondary prophylaxis
° patient monitoring e.g.
- CD4 counts
- vival load
- immunological
° role of family and community in
promoting adherence and basic counselling 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
catchments 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 and OI drugs to be used in comprehensive care clinic
centres in the health facilities in the programme catchments area. The
programme will facilitate referrals of 50 people to comprehensive care
services.
3.5 Conduct trainings of Self-help
Projects for people living with HIV/AIDS
The aim of the programme is to
organise 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 o 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
impact mitigation
strategy, since HIV/AIDS is 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 organisation or movement in the fight against HIV/AIDS pandemic
in the society.
Self-help projects, as community
mobilization and organisation 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-organisation and participation in development.
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 maximising
learning experience for people living with HIV/AIDS on the challenges affecting
their life, 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/AIDS
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 and build a 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 KShs 1.040.000, targeting HIV positive dropout
pastoralist at satellite centres
° camel dairy (milk) project at a
cost of KShs 300.000 i.e. 10 camels at KSHs 30.000 each,
targeting pastoralist 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
Programme aims at facilitating provision of food for HIV positive people,
particularly during the periods of drought when 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 90 kg of maize, 30 bags of 90 kg of beans, 30 bags of 50 kg of rice,
30 bags of 25 kg of Unimix and 20 Jeri cans of 20 ltrs 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 KSHs 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 KSHs. 4.000 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 to
secondary students who are HIV/AIDS orphans and vulnerable children, by
facilitating payment of school fees at a rate of KSHs. 8.000 per term and a
transport fee of KSHs. 2.000 per term for a period of 3 years.
3.11 Support for payments of health
care bills for people living with HIV/AIDS and orphans
As a result of burden of health care
bills, the programme propose to facilitate payment of hospitalization bills for
PLWHA 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 KSHs. 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 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 counselling skills
° safe water and hygiene
° nutrition care
° benefits of ART and OI drugs
° benefits of good adherence
° benefits of HIV-sero-status
disclosure
° the role of family and community
in care for PLWHA
° core principles of HIV testing and
counselling
These workshops will be conducted as
part of mobile/outreach integrated services, at the community level, targeting
pastoralists.
3.13 Support community-based
linkages for people living with HIV/AIDS
The aim of implementing this
activity is to form a broad base partnership for the implementation of
programme activities in order to attain the desire goals and objectives.
The programme aims at organising 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 organisation leaders
° non-governmental organisations
° community-based organisation
° community-socially organised
groups
° youth representatives
° women groups representative
° Ministry of Medical Services and
Public Health and Sanitation
° humanitarian organisations
The programme will also plan to
conduct 2 workshops for stakeholders. In this workshop the following key
areas/themes will be focused on
° benefits of partnership in
development projects
° community resources 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
implement this activity, in order to perform monitoring of support groups
performance at the community level. This is to detect deviation from the
proposed plan and design corrective action/measures in time. It is also
monitoring precise target milestones and targets for physical performance.
The programme 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
° resources 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. This meeting will be conducted
at least two times a year.
3.15 Support referrals of people
living with HIV/AIDS 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
programme will use mobile/outreach integrated services as a detection strategy
for patients/clients in need of comprehensive care services.
Referral forms and registers will be
used to document this activity.
A total of 300 people will be
targeted for referral 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 propose 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
° diseases of stigmatisation and
discrimination
° role of family and community in
the fight against HIV/AIDS stigmatisation and discrimination
° concepts of community mobilisation
° community mobilisation strategies
° 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 strengthening
4.1 Support male and female condom
education and distribution
Male and female condoms are
inaccessible to the pastoralist in the rangelands and therefore there are 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 pastoralist in the rangelands.
The programme will mobilize
contraceptives from Ministry of Public Health and Sanitation and facilitate
accessibility through programme outreach health services strategy to the
pastoralist communities in the catchments 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 infections
services are never accessible to the pastoralist in the rangeland except for
pastoralist at the satellite centres where the health facilities are located.
The programme will be to access this
service to pastoralist at the rangeland, through mobile/outreach health
services programme.
Awareness messages 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 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 health
services programme:
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 the reproductive health rights and services.
The aim of the programme will be to
create and build awareness of 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 counselling
The programme will aim at screening
family planning clients for sexually transmitted infections and HIV/AIDS in
cases of unknown status.
HIV testing and counselling 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 STIs 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, herpes simplex virus type 2)
The programme will aim at targeting
40 family planning clients and 50 STIs patients within a period of 3 years.
5.0 Maternal Health Care Services 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. The package of care will focus on the following
° focused antenatal care (FANC)
° intermittent preventive treatment
e.g. malaria in pregnancy
° prevention of mother to child
transmission (PMTCT)
° tuberculosis screening and
referral in pregnancy
° enhance 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 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 pregnancy, 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
° immunisation
° 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 input in a health service delivery system and therefore the
programme will propose supply of drugs in order to facilitate service delivery
at the outreach service delivery points 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
haemorrhage which is a leading cause of maternal mortality in
The programme aims at conducting
community public meetings for awareness on the benefits of 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 foetal 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
° foetal movement and foetal 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 programme focus at targeting 50
mothers by 2012.
5.4 Support Vitamin A
supplementation for lactating mothers
Vitami A supplementation is a
national strategy aimed at promoting child survival by reducing childhood
morbidity and mortality. 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 mothers for Vitamin A supplementation in 3 years period.
5.5 Support nutritional
supplementation for vulnerable pregnant and lactating mothers
Nutrition is vital for foetal growth
and well-being in the uterus as well as healthy development in future. Adequate
quantities essential of essential amino acids derived from proteins are
essential for development of organs during the period of organ formation in
foetus. Amino acids are the building blocks of brain cells and the entire
nervous system of a developing foetus in uterus. This determines the child’s
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 and
mortality.
This activity aims at targeting 100
mothers to benefit from the programme in 3 years period.
5.6 Support supply of essential
drugs for medical treatment in pregnancy and childbirth
The programme aims at facilitating
the supply of essential drugs for management of medical conditions in pregnancy
and childbirth, this is in order to reduce maternal morbidity and mortality. A
total of 100 pregnant and postnatal mothers will be focused by the programme
through mobile health care services.
6.0 Child Health Care Services improved
6.1 Conduct community integrated
management of childhood illnesses workshops
Integrated management of childhood
illnesses is WHO strategy adapted globally aimed at reducing childhood
morbidity and mortality, particularly in developing countries. Pastoralist Foundation
for Life integrated outreach health care services programme aims also at
implementing IMCI strategy at household and community level among the
pastoralist community.
Community IMCI strategy aims at
strengthening household-based preventive strategies in order to reduce health
hazards at the child’s environment and therefore reduce child morbidity and
mortality.
The programme will organise and
conduct workshops focusing on the following strategies
° breastfeeding
° supplementary feeding
° provision of micronutrients e.g.
vitamins
° immunisation. Main symptoms in
IMCI
° malaria prevention and management
° promotion of child mental and
social development
° feeding of sick children. General
danger signs in IMCI
° referral of sick children
° vaccination of pregnant mothers
with tetanus toxin vaccine. Safe disposal of stool and hand washing with soap
and water
° preventive measures against
HIV/AIDS
° prevention of child abuse
° reproductive health
° prevent and beat child injuries
The above are household and
community practices for IMCI which the programme aims at strengthening
implementation at pastoralist households.
The programme is aiming at
conducting two workshops, targeting 120 participants in a 3 years period.
The programme will target the
following beneficiaries
° pregnant mothers
° breast feeding mothers
° adolescents and youth
° men (e.g. male involvement in
IMCI)
6.2. Conduct mobile immunisation
services
Expanded programme on immunisation
services are inaccessible to the pastoralist community. Outreach/mobile
services strategy becomes the only realistic means of accessing vaccination to
children and pregnant mothers. Immunisation as one of the global strategy for
reducing childhood morbidity and mortality will be a key strategy for promoting
pastoralist child survival. Resources input for the activity will be from
MOPHS.
The programme aims at targeting 500
children and pregnant mothers in 3 years time.
6.3. Support nutritional
supplementation for children with acute malnutrition (IMAM)
Worldwide, malnutrition is one of
the leading causes of morbidity and mortality in childhood. Severe malnutrition
in infants is common in developing countries. Food deficiency characteristics
displayed by pastoralist communities include the following
° insufficient food at household
° inadequate knowledge of feeding
technique
° improper feeding habits
° poor hygiene
These factors expose pastoralist
child to malnutrition. Drought is also a prevalent feature in pastoralist
occupied regions. This is also characterised by household food deficiency and
therefore childhood malnutrition with
immunodeficiency resulting into pneumonia and diarrhoeal diseases.
The programme aim will be to
integrate management of acute malnutrition with programme activities.
A total of 120 children will be
targeted within a period of 3 years.
6.4 Support supply of essential
drugs for integrated management of childhood illnesses (IMCI)
Shortages of essential drugs at
health facility level is a common feature in pastoralist areas due to unreliable
drugs supply logistic system. Frequent shortage of essential drugs and
inaccessibility of health services contribute to childhood mortality.
The programme will propose supply of
health services contribute to childhood mortality.
The programme will propose supply of
essential drugs for IMCI activities at the outreach services. IMCI activity
will target to provide care to 200 children by the end of 2012.
6.5 Support school health programme
services
This activity aims at promoting
child health in the pastoralist areas. The programme will provide the following
health services
° screening for minor illnesses and
providing treatment
° physical examination for disorder
° assessing immunization status
° revaccination for BCG vaccine and
tetanus toxoid vaccine for those with wounds
° referral for children with major
disorders to health facilities
° deworming and Vitamin A
supplementation
° voluntary counselling and testing
° health education and workplace HIV
counselling and testing
The programme will target Nursery,
Primary and Secondary Schools in the catchments area.
It will target at least 20 schools
with a total population of 500 beneficiaries
APPENDIX 5a:
BUDGET SUMMARY BY OUTPUT FOR PASTORALIST FOUNDATION FOR LIFE
|
|
OUTPUT |
YEAR 1 2010 |
YEAR 2 2011 |
YEAR 3 2012 |
TOTAL FOR 3 YEARS |
|
1. |
Community-based HIV Testing and Counselling
promoted |
1,891,909 |
1,396,909 |
698,409 |
3,987,227 |
|
2. |
Prevention of Mother to Child Transmission of
HIV/AIDS promoted |
272,000 |
400,000 |
80,000 |
752,000 |
|
3. |
Community Care and Support for People living
with HIV/AIDS and orphans improved |
3,290,833 |
2,666,833 |
1,430,833 |
7,388,499 |
|
4. |
Reproductive Health Care Services strengthened |
330,000 |
330,000 |
|
660,000 |
|
5. |
Maternal Health Care Services improved |
1,111,666 |
554,666 |
554,660 |
2,220,998 |
|
6. |
Child Health Care Services improved |
789,569 |
789,569 |
789,569 |
2,368,707 |
|
|
SUB - TOTAL |
7,685,977 |
6,137,977 |
3,553,471 |
17,377,431 |
|
|
10 % inflation factor for year 2 and 3 |
- |
613,798 |
355,347 |
- |
|
|
Total output budget
including inflation |
7,685,977 |
6,751,775 |
3,908,818 |
18,346,570 |
|
|
5 % contingency of total output oriented
budget |
384,299 |
337,589 |
195,441 |
917,329 |
|
7. |
Personnel and vehicle hire/maintenance |
2,506,000 |
2,764,200 |
3,038,072 |
8,308,272 |
|
|
TOTAL |
10,576,276 |
9,853,564 |
7,142,338 |
27,572,178 |