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One-stop health shop for Kenyan pastoralists

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Under the scorching morning sun of northern Kenya, women and their children wait patiently under a tree for their turn with the outreach team.

Around them are water containers and goats. Close by are the men whose livestock is being attended to by veterinary officers working alongside the health officers.

This is Natole village in Kibish region of Turkana County at the border confluence of Kenya, Ethiopia and South Sudan. It lies within the Elemi triangle, a historically disputed land among the communities from these three countries.

People here are pastoralists, who are always on the move, seeking not only for pasture and water for their livestock, but also to elude cattle rustlers.

Without roads, access to the community is a challenge. Only heavy duty vehicles can traverse this hot, dusty region and during the rainy season, movement becomes hampered by floods.

Healthcare in this region remains a challenge not only due to widespread environmental degradation, food insecurity and malnutrition but also because a large percentage of these populations is not insured.

They have to trek long distances to reach health facilities that are either understaffed or have no qualified medical staff.

Llipsini Ekuwam, 28, is at the health outreach organised by Afya Timiza in partnership with the Ministry of Health and the Turkana County.

Known as Kimormor (a Turkana word meaning “all together”), this is an innovative is funded by USAID to connect nomadic communities with basic health services.

Llipsin arrived at the centre at 9am with her two-year-old son just before the health officers got started.

“I walked for about three hours to get here,” she said.

The mother of three says she has never delivered at a formal health facility and never attended an antenatal clinic.

Her children have never been immunised or been to a hospital for medical check-ups.

Seeing how her children are spaced, one would think that this is a result of family planning. But that would be untrue considering Llipsini has suffered three miscarriages.

“Every two years, I conceive and at some stage I get a miscarriage but then the next pregnancy makes it to term. I think this is OK because the miscarriages clean up my womb and prepare it for the next baby. That is why the pregnancy that follows is always a success,” said Llipsini, adding that all her children are healthy and have no complications so she sees no need to worry.

She has never used any family planning device or method and believes that how a woman gives birth is up to God, something that cannot be controlled.

“All you are supposed to do is wait until God gives you another baby,” Llipsini added.

Even the idea of taking her children to a clinic is news to her. “I have never heard of it nor have I seen other women doing that,” she said.

Llipsin’s son is among other children who were dewormed, weighed and their height taken to ascertain their health status and whether they are malnourished. Her baby’s weight and height are fine for his age.

“I came here because the health volunteers talked to my husband about it and he asked me to come with this baby. The other two children are at home taking care of the goats,” said Llipsin.

“If family planning is as good as the community health volunteers say then continue talking to us about it and we will change. We have started bringing our children for check-ups and are now aware of the importance of attending antenatal clinics and making safe deliveries at the health facility.

Eventually, when we experience the benefits of family planning and our husbands agree to it then we will take it up too,” Llipsin adds.

After discussing the topic with the health workers at the outreach centre, she promises that the next time she is at Kimormor outreach she will consider trying out the family planning services.

The campaign is done quarterly as a follow up to the monthly facility-based outreaches that offer human healthcare services only.

The various service departments meet at the county headquarters in Lodwar where department heads of the targeted services are located.

To initiate the outreach, the Afya Timiza team delegates community health assistants, community health volunteers and the area chiefs encourage the Emuron and Kraal leaders to mobilise their communities along every mapped migratory route.

Water points a provide a strategic location for setting up the outreach. As the community’s stop to water their animals and replenish their water supply they also receive the services.

“We get the information on the migratory routes to follow from the Ministry of Water office. This saves time spent on trying to reach the people,” said Gilbert Wangalwa, chief of party of Afya Timiza.

At the service delivery point, each department is tasked with its core mandate.

For example, the Ministry of Health provides human health services including antenatal care, postnatal care, immunisation, screening for malnutrition and providing the nutritional supplements as well as HIV/Aids testing and counselling.

The Ministry of Livestock, Agriculture and Pastoral Economy deworms and treats animals and also sensitises communities on the importance of growing locally available foods.

At the outreach centre, men accompany their families as they bring along their livestock for veterinary services.

“Most of the time we use the men to pass along the message and so as they come for the veterinary services, they come along with their families,” he said adding that the strategy has worked well because in Turkana the men are the overall decision makers.

On this day John Lomulen has brought his animals for deworming and vaccination. Lomulen has three wives. His first wife has accompanied him for family planning services.

Although he is happy that his cows have been vaccinated, he is not sure that it is a good idea for his wives to use contraceptives.

“What if the bandits come and kill our children? I still think we need to have as many children so that if some are killed we have some left,” said the 40-year-old.

He said that if they had better arms to protect themselves from the cattle rustlers, they would take family planning seriously.

Lomulen first heard of the Kimormor outreach from Faustino Muya, a community health officer, who was going around educating people about health.

Mr Muya and his colleagues use digital devices known as Digisomo to sensitise the community.

The Digisomo is a simple battery-operated computer audio device that is not dependent on the Internet or electricity.

It is loaded with standardised messages translated into the Turkana and Samburu languages on the five thematic areas of family planning, reproductive, maternal, newborn, child and adolescent health as well as nutrition and WASH (an acronym that stands for “Water, Sanitation and Hygiene”).

Universal, affordable and sustainable access to WASH is a key public health issue within international development and is the focus of Sustainable Development Goal 6.

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