SOURCE: Lionel Faull/Bhekisisa/CHAT
This month we feature our fellow Population & Sustainability Network member, Communities Health Africa Trust (CHAT), an NGO working to promote healthy, empowered and self-sustainable living among poor and excluded communities in Kenya. This article by the South African Mail & Guardian's Centre for health journalism, Bhekisisa, features CHAT's nurse Pauline Nunu as she travels with her camel clinic, bringing mobile health services to the remotest areas of Kenya.
Camels bring healthcare to rural communities in Kenya
It's long before dawn in the thorny scrublands of northern Kenya. A recalcitrant camel grunts as nurse Pauline Nunu fastens the wooden boxes filled with medical supplies. Her small team is used to working fast and in the dark: breaking camp and loading the bulky boxes onto the backs of their eight camels. They have to get to the next settlement while the morning is still cool. The terrain ahead is rough and full of dangers.
"Distances are so long," says Nunu, who is in her mid-forties. "Sometimes you have to walk between four and six hours."
In this vast and scenic area of northern Kenya, the mobile camel clinic team treks between communities for up to six hours a day. The area is underdeveloped, remote and vast. When Nunu completed her training in HIV counseling and testing, she never thought she would end up depending on camel handlers' bush tracking skills to avoid stumbling into a herd of elephants. Or, as she says with a shudder, nearly step on a deadly puff adder snake sunning itself in a path.
The seminomadic communities here are peppered across 30 000 square kilometres of arid bush. They sorely need medicine and care. But there is only one doctor for every 63 000 people in the Laikipia and Samburu counties, according to government revenue allocation data. More than two-thirds of the population lives below the poverty line and nearly a quarter of children younger than five are at risk of malnutrition.
"You find that the men make all the decisions," Nunu says. "Women still have no say."
Out in the wild, the medical team rely heavily on the survival skills of the camel handlers. Here, they draw on traditional knowledge to dig a shallow well in a dry riverbed. In these communities, Nunu's camel mobile clinic is often the only health service people access in months. She is a veteran of the Communities Health Africa Trust (Chat), which brings mobile health services to the remotest areas. They focus on family planning and basic reproductive services, but also raise ecological awareness.
The fragile ecosystem here is buckling under alternate droughts and floods. This is exacerbated by environmental degradation, caused in part by a rapidly growing population. Rain upstream can turn this seasonal river into a raging torrent in just a few hours, and delay the mobile clinic’s progress.
"Right now there are floods," Nunu says, "The rivers are swollen all over. We have to wait for the water to go down before we can cross." Intense competition among pastoralist communities for ever-scarcer grazing land has led to "tribal clashes and insecurity", Nunu explains.
Her colleague Violet Otieno says clinic staff is sometimes caught between warring communities: "Most of the time the people we are serving shield and protect us. But we stay close to the chiefs' houses or police posts for security, and the injured then come to us for treatment."
A Samburu moraan (warrior) and his wife accompany the camels to the next clinic. While serving the community, the camel clinic team relies on locals for protection and support.
Chat was started 15 years ago by Sharon Wreford-Smith, who was born in Kenya and has lived in Laikipia most of her life. While the camel mobile clinic operates in remote areas, a purpose-built Landrover mobile clinic criss-crosses wherever it can, in an area where more than 90% of the roads are untarred.
HIV testing on two wheels
The organisation has also developed a network of "community-own resource persons" (Corps) who prepare people in advance of the clinic's arrival. Trained in family planning or HIV testing and counseling, these community members provide ongoing support when the clinic moves on. A recent innovation has been "backpack mobiles", which allow Corps to carry a mini-clinic with them as they go door-to-door in their communities.
Samwel Parare makes a living as a boda boda (motorbike taxi) driver. As a Corp in Laikipia North, Parare's day job melds seamlessly with his HIV testing and counseling work. Parare carries his HIV testing kits with him, provides on-the-spot counseling, and refers anyone who tests positive to their nearest clinic. But the men here, for a variety of cultural reasons, do not approve of their wives, daughters or partners accessing these services.
"There are many practices – such as female genital mutilation, beading [culturally accepted casual sexual liaisons between young men and girls], early marriages, polygamy, bush abortions and traditional medical beliefs – which make life very difficult for women," Parare explains.
Dispensing medicine provides a pretext for women to come to the clinic for their regular family planning insertions. Men who come to the clinics for basic healthcare are encouraged to have an HIV counseling and testing session, or to sit under a thorn tree listening to Parare explain family planning and ecological awareness.
"They think contraception is a way to stop a woman from giving birth forever," says Parare, who often gives talks to groups of knobkierie-wielding men. "But once we have helped them understand that it's just a matter of spacing, of allowing each child to grow properly, rather than being a permanent thing for women, that's when they allow their woman to access services. They also get a positive response from other beneficiaries, and can start to accept it."
Answering the call
Nurse Pauline Nunu and a colleague examine a patient with a chest complaint. Last year, Chat reached 140 980 people, with the Corps and Landrover clinics serving the majority. But the camel team added a crucial 8 663 people in the furthermost areas who might otherwise not have been served. Nearly 5 000 people received basic medicines for ailments such as malaria, diarrhoea and skin infections. In a day Nunu will provide basic medicines to between 20 and 30 patients and see up to 80 clients for family planning.
"When a client comes for insertion, she decides for how long, and then I do a pregnancy test. If it's negative, she chooses the method she wants. It could be a one-month pill, or a three-month injection or a three-year insertion. Then I do the insertion in the privacy of a tent." Last year, the clinics administered family planning to 40 604 women; more than half of whom chose a three to five-year insertion. It also distributed more than 200 000 condoms.
"When we provide people with it (contraception), maternal health complications go down. Economically, people become better off."
For Nunu, her work is "a passion to serve this community". "You know, when we went for training it was like a call. And when we serve the community to which we are called, we feel content."
You can access the original article here.
Linking reproductive health, sustainable development, and conservation: Insights and experiences from the Population & Sustainability Network and its membersSeptember 30, 2016
SOURCE: PSN and PRB
PSN's Chief Executive, David Johnson, and Policy and Advocacy Manager, Carina Hirsch, joined PSN members, IPPF and its latest member, PRB, for a webinar sharing insights into the links between family planning and reproductive health to other sectors such as conservation and climate change.
Linking family planning and reproductive health to other sectors—such as conservation and climate change—to achieve sustainable development is not new, but some opportunities to collaborate may not be well-known. For example, the Intergovernmental Panel on Climate Change—the scientific body which reviews existing climate science and informs the United Nations Framework Convention on Climate Change (UNFCCC) and Conference of Parties (COPs)—recognises family planning as a potential adaptation strategy. However, few people in any sector are aware of this opportunity.
In an Africa Population, Health, and Environment (PHE) webinar hosted by PACE, the Population & Sustainability Network (PSN) and two member organisations, the International Planned Parenthood Federation (IPPF) and the Endangered Wildlife Trust (EWT) joined Population Reference Bureau (PRB) to share insights and discuss how PSN and its members advocate for family planning to benefit conservation and sustainable development.
Kristen P. Patterson of PRB welcomed participants. David Johnson and Carina Hirsch, both of PSN, shared the history and role of PSN, which launched in 2004. Its 17 member organizations include national and international NGOs, academic institutions, international organizations, and government bodies. Many of these groups advocate for, design, and implement PHE projects in African countries. PSN advocates for and brings attention to PHE projects in various international forums and brings partners together.
For example, Bridget Corrigan of EWT explained how PSN facilitated and brokered links to organizations that enabled EWT to integrate family planning interventions into programs where communities expressed a need for reproductive health services. One such partnership is the Groot Marico PHE project, now in its early implementation stages.
Similarly, Alison Marshall of IPPF shared that membership with PSN has been an effective way to advocate for voluntary, rights-based family planning with a particular focus on climate change and other environmental issues. PSN and IPPF have jointly advocated at the UNFCCC COPs and are now collaborating on an advocacy toolkit.
Following the presentation, Patterson led a lively Q&A session with questions from the audience, who joined the webinar from various countries around the world, including many in eastern and southern Africa.
This webinar is part of the Africa PHE webinar series implemented under the Policy, Advocacy, and Communication Enhanced for Population and Reproductive Health (PACE) Project.
This month we feature an update on a new programme of our fellow Population & Sustainability Network member, CHASE Africa, an NGO working to improve access to family planning and healthcare, and increasing the resilience of the natural environment in Kenya and Uganda. CHASE Africa’s innovative approach, combining support for mobile clinics and tree planting projects, is helping to make this a reality. Robin Witt writes about his experiences in Kenya and the success of CHASE’s integrated health and conservation projects.
CHASE Africa, originally called the Rift Valley Tree Trust, was established in 2000 to encourage tree planting around the fast disappearing Mau forest in Kenya. Starting tree nurseries was easy but finding secure land to plant the trees on proved much more difficult. Many schools have relatively large plots and we have now completed tree planting projects at more than 90 schools, with plots ranging from a half to two acres. Some of the first schools to take part in the planting project are now beginning to harvest their trees. Some schools have chosen to sell the timber, some use it to cook the school lunch and two had the timber milled and built new classrooms.
One of the ideas behind the school tree project was that the timber produced would take some pressure off the indigenous forest. However, the forest seemed to be disappearing at an ever-increasing rate and the size of a farm holding was becoming ever smaller. The reason behind this was Kenya’s population was growing by around one million a year. This coupled with the fact that many rural women had no access to family planning, and were having more children than they wanted, we decided to shift the main focus of our work to helping meet the unmet demand for family planning. The Kenyan Government is now strongly in favour of ensuring family planning is available to everyone. However, in rural areas provision of services is weak due to economic and logistical difficulties. Today, we work with four partners in Kenya and one in Uganda, and over the last four years, we have helped over 54,000 women to have access to family planning.
One of our partners, Dandelion Africa, works in Baringo County in Kenya. This semi-arid county has a contraceptive prevalence rate of only 33%, which is the percentage of women who are currently using, or whose sexual partner is currently using, at least one method of contraception. Dandelion is enabling many women who have never had access to contraception the chance to plan their family size by running mobile clinics that come to their communities. Dandelion, working in conjunction with the Ministry of Health (MoH), decides which communities are to be visited by first holding a meeting with the area Chief and other relevant individuals, to discuss the forthcoming clinic. Key to the success of a clinic is the work of the community health workers who, in the weeks leading up to the clinic, spend time discussing all the benefits family planning can bring and dispelling many of the myths that abound. Local radio in these rural areas is a key form of communication and Dandelion advertises where and when clinics will be happening. On the actual day of the clinic, eight staff are contracted from the MoH on a locum basis. These include two doctors, three family planning and cervical cancer nurses, one antenatal care officer, one HIV/AIDS tester and counsellor and one pharmacist. Often a church hall or school buildings will be used to house the clinic but if these are not available small pop-up tents are taken.
A typical day-clinic comprises the following services, general GP services, immunization, deworming, cervical cancer screening, family planning, and HIV/AIDS testing and counselling, generally with over 1,000 people attending. Family planning patients can choose between different contraceptive methods, including the pill, a 3 month injectable contraceptive, Depo-Provera, a 3 or 5 year contraceptive implant, or an IUD. Female and male condoms are also distributed. The number of women attending for family planning normally varies between 100 and 200.
There are many benefits of enabling women to have the chance to choose family planning, the main ones being maternal health is improved, abortions are reduced and there is a positive impact on under-fives mortality. Traditionally in these rural areas, parents could often not afford to send their daughters to secondary school, sending their sons in preference. When parents can choose how many children they have, all of their children stand a much better chance of being educated and it is well known that one of the key things in reducing total fertility is the education of girls.
CHASE Africa is a small NGO with limited funds but what it has shown is there is a very high unmet demand for family planning in rural areas of Kenya, and for relatively modest sums, that demand can be met and a family’s fortunes, and perhaps the planet’s as well, can be changed for the better.
We are delighted to welcome the Population Reference Bureau (PRB) into our Network. PRB works to inform people around the world about population, health and the environment, and empowers them to use that information to advance the well-being of current and future generations.
Based in Washington, DC, in the United States, PRB is committed to empowering people with knowledge. It analyses and interprets demographic, health and environmental data and trends, and shares that information with people and organisations at all levels. From decision makers and community leaders, to youth in the US and internationally, the information PRB shares helps advocate for and enact policy changes, advancing the health of people around the world.
Kristen P. Patterson, Programme Director for Population, Health and Environment at PRB said, “I appreciate the Population & Sustainability Network’s enthusiasm to further engage the conservation community to support reproductive health and sustainability by recently joining the IUCN. I look forward to collaborating with PSN and its Members to promote positive messages around population, reproductive health, and sustainability and expand support for integrated population, health, and environment approaches to sustainable development at the country level as a means of efficiently and effectively achieving the SDGs.”
Jeffrey Jordan, President and CEO of PRB said, “We are proud to add our evidence-based research, capacity-building and advocacy voice to the Network and look forward to continued collaboration with PSN and all its Members.”
David Johnson, Chief Executive of PSN said, “We are not only excited that PRB have become our latest Member, but also that we will be marking that membership tomorrow, when we host our first joint webinar.” On Wednesday 14 September 2016, PRB in partnership with PSN and fellow PSN Members the International Planned Parenthood Federation and the Endangered Wildlife Trust, are hosting a webinar on the links between reproductive health, sustainable development and conservation. Topics discussed will include past and future advocacy activities on the connections between family planning and climate change, COP22 activities, FP2020 linkages, and a new population, health and environment project being implemented by PSN and the Endangered Wildlife Trust in South Africa.
The webinar will take place between 4pm and 5pm East Africa Time (Ethiopia, Kenya and Uganda); 3pm and 4pm South Africa Standard Time; 9am and 10am Eastern Daylight Time (Washington, DC); and 2pm and 3pm (London).
The partnership between PSN had PRB pre-dates PRB’s formal membership of PSN. PSN’s Projects and Communications Manager, Kat Lloyd, said, “Back in 2015 PSN was honoured to be invited to participate in a PRB expert working group on population dynamics and climate compatible development, which comprised experts from the climate change, family planning, and development assistance communities and we’re pleased that we can today announce we are deepening this collaboration further.” The expert working group recommended the inclusion of universal access to voluntary family planning in climate compatible development plans. PRB and PSN anticipate that PRB’s membership will only enhance the two organisations’ work together on these critically important issues.
The Population & Sustainability Network is proud to announce its membership of the International Union for Conservation of Nature and Natural Resources (IUCN). Created in 1948, IUCN is the world’s largest and most diverse environmental network, harnessing the knowledge, resources and reach of 1,300 member organisations and some 15,000 experts.
In becoming an IUCN member, the Population & Sustainability Network aims to influence global conservation policy, to ensure sexual and reproductive health and rights are given due prominence by the conservation sector. Almost invariably it is rural communities in the developing world which face the greatest barriers to unrestricted access to contraceptive services. These same rural areas, where the conservation sector operates, are those where the inextricable links between poor health, unmet family planning needs, population pressures, environmental degradation, vulnerability to climate change and food security are most obvious.
David Johnson, the Population & Sustainability Network’s Chief Executive, said, “In a world with a population projected to increase by a third, from today’s 7.4 billion, to 9.9 billion in 2050, unrestricted access to family planning information, rights and services are not only critical for women’s health and empowerment, but also many other development issues too. That includes environmental and conservation challenges.” The Population & Sustainability Network questions whether many existing traditional conservation programmes can possibly be successful in the long term, unless these demographic realities are taken into account in conservation programme design. One way to take them into account is to create new partnerships between the conservation and health sectors.
The Population & Sustainability Network is the international programme of the Margaret Pyke Trust, a UK charity founded nearly fifty years ago. The Trust has been at the forefront of contraceptive developments since its foundation, from provision of clinical services in its early days, to academic research, programme delivery and international reproductive health advocacy more recently. Carina Hirsch, Advocacy and Policy Manager said, “We believe we are the first IUCN member, of the 1,300 existing members, with a primary mission focussed on reproductive health. We’re excited about using our specialist expertise to help shape the conservation policies of the future”.
The Trust launched the Population & Sustainability Network in 2004, at the UN Commission on Sustainable Development, and has promoted reproductive rights as part of sustainable development ever since. David Johnson concluded, “Having already built a reputation in United Nations Framework Convention on Climate Change processes, such as at the recent COP21 in Paris, IUCN membership builds on the Trust’s advocacy strategy of promoting sexual and reproductive health and rights to a broader audience.”
The IUCN provides a neutral space in which stakeholders including governments, NGOs, scientists, businesses, local communities, indigenous peoples organisations and others can work together to forge and implement solutions to environmental challenges and achieve sustainable development. The Population & Sustainability Network’s IUCN membership will bring a new and distinct voice to discussions about how to implement those solutions.