SOURCE: Blue Ventures
This month we feature our fellow Population & Sustainability Network member, Blue Ventures, a renowned Marine conservation organisation. Blue Ventures has been integrating community-based family planning and other health services with locally led marine resource management efforts and alternative coastal livelihood initiatives along the western coast of Madagascar for the past decade. This holistic approach is often referred to as "PHE" because of the way that it reflects the connections between people, their health and the environment.
In resource-dependent and under-served settings, challenges such as poor community health, unmet family planning needs, food insecurity, resource depletion and environmental degradation often interact and compound each other in increasingly negative ways. PHE is a joined-up approach designed to stop and reverse these vicious cycles by kick-starting a series of positive chain reactions: enabling couples to plan and better provide for their families, improving their food security, and equipping them with the skills they need to manage their resources sustainably.
In the first site where Blue Ventures developed its PHE programme with health partners including Marie Stopes Madagascar, the proportion of women using contraception has increased more than fivefold since 2007 and recent elections of the committee governing the locally managed marine area in the region saw female representation increasing from 13% to 38% of general assembly members. The community health component of Blue Ventures' PHE programme is known locally as "Safidy", meaning "the freedom to choose" or "choice", reflecting the organisation's commitment to upholding reproductive rights and enabling all individuals to make free and fully informed family planning choices.
Blue Ventures' distinctive style of working emerged through conversations with local communities, which challenged the organisation to appreciate the ways in which human and ecosystem health are intertwined. Their unconventional journey in conservation began through listening. They learned that people in Madagascar’s first locally managed marine area thought that fish stocks would collapse without improved access to family planning. They also saw that, as a field-based organisation working with these isolated communities, they were ideally positioned to address this critical unmet need with health partners in the region.
Today, Blue Ventures' PHE programmes reach more than 25,000 people along Madagascar's western coast and the organisation plays a leading facilitatory role in Madagascar's national PHE network. This network was established in 2014 to facilitate and support the creation and development of PHE partnerships among health and environmental organisations working in some of the island's most biodiverse and under-served zones. This platform is enabling Blue Ventures to share its PHE experiences and learning with numerous like-minded organisations while uniting Madagascar's health and environmental sectors to achieve and sustain meaningful changes for people, their health and the environment.
In April 2017, Dr Marian Davis will become the Margaret Pyke Trust’s first runner to take part in the London Marathon. Marian will be running to raise money for the Margaret Pyke Trust, with the Population & Sustainability Network, to help improve sexual and reproductive health around the world.
Dr Marian Davis is no stranger to a challenge. Running her first marathon at 49, she has gone on to complete more than six marathons and five half-marathons in over five different countries. There is, however, one marathon that she has always wanted to enter - the London Marathon.
“We’re thrilled to have Marian as our first Margaret Pyke Marathon runner. She will be joining around 36,000 runners in one of the world’s most famous running events, taking her past some of London’s most iconic landmarks, and we’re honoured that she will be running to support the Trust”, said David Johnson, Chief Executive of the Margaret Pyke Trust.
“I am delighted to be running the London Marathon for the Margaret Pyke Trust. The organisation has worked for over 50 years, both in the UK and internationally, providing training in contraception and reproductive health to clinicians. As part of the Population & Sustainability Network, they work towards improving reproductive health as a step towards empowering women, eradicating poverty and sustaining the environment, which is something I feel very strongly about.”, explained Marian.
In November, Dr. Sue Mann provided contraceptive training in Uganda, becoming the first “Margaret Pyke Volunteer” in a new programme continuing the legacy of a family planning pioneer.
The Margaret Pyke Trust has been a leader in contraception and sexual health for nearly 50 years. Named after Margaret Pyke, a family planning pioneer, the Trust is the UK’s leading provider of contraception training for doctors and nurses. Building on this success, the Trust launched a volunteering programme which places doctors and nurses at sites identified by Population & Sustainability Network members and at the Trust’s own African project sites with significant need for sexual and reproductive health training.
Dr Sue Mann, a Consultant in Public Health and sexual and reproductive health, travelled to Bwindi in south-west Uganda to provide contraception training to healthcare workers and to assist at a mobile health clinic in an isolated village near Bwindi Impenetrable Forest National Park. At 5.8, Uganda’s fertility rate is one of the highest in the world, as Ugandan women, on average, give birth to nearly two children more than they want, and rural women are twice as likely to encounter barriers to family planning than their urban counterparts.
The growing local population also increases pressure on the local environment, and Bwindi Impenetrable Forest National Park is home to numerous wildlife species, including endangered gorillas and chimpanzees.
Population & Sustainability Network member, Conservation through Public Health (CTPH), has been working around the national park for over 10 years and Dr Mann accompanied CTPH staff and healthcare workers at a mobile health clinic, a three hour hike through the forest. The mobile clinic was funded by another Population & Sustainability Network member, CHASE Africa, and provided basic healthcare and family planning services, the first time all three Population & Sustainability Network members had collaborated on a single project.
Dr. Sue Mann spent her final week in Uganda providing training to nursing staff at Bwindi Community Hospital. The training is part of a pioneering programme called USHAPE, which strengthens sexual and reproductive health services in rural Ugandan hospitals.
David Johnson, Chief Executive of the Margaret Pyke Trust said, “We’re delighted that Dr. Sue Mann’s visit to Uganda was such a success and hope more clinicians will volunteer their time to help improve family planning services overseas, as there are an estimated 225 million women in developing countries who would like to delay or prevent childbearing but are not using an effective method of contraception. These women are the focus of the Margaret Pyke Volunteer programme.”
In the run up to COP22, the 2016 United Nations Climate Change Conference, the Population & Sustainability Network and the International Planned Parenthood Federation have joined forces to develop a toolkit for family planning advocates; providing them with the knowledge and tools to engage effectively in climate policy discussions and promote family planning as an effective climate adaptation strategy.
As climate discussions get underway in Marrakech, family planning advocates are using our toolkit, Climate Change: Time the "Think Family Planning", to impress upon climate change decision-makers the critical need to “Think Family Planning” as they develop plans to address the threats of climate change.
At last year’s Climate Change Conference in France, countries agreed the text of the Paris Agreement, which has now entered into force. This means we must now look to the future and work out how each country is going to implement so-called climate “adaptation” strategies. These adaptation strategies are ways communities can cope better in the face of a changing climate. Family planning has been accepted by UN scientists as one type of adaptation strategy.
It is important that all countries include family planning actions in their national plans and planning processes, and then ensure family planning actions are incorporated into national climate adaptation strategies. Family planning is a human-rights based adaptation strategy, and a particularly cost-effective strategy too. As the global population continues to grow, it becomes harder to meet the needs of citizens. When there are barriers to accessing family planning services, it hampers everyone’s ability to adapt to climate change.
Join us in encouraging leaders that when it comes to climate change, it is time to think family planning.
Watch our video about how family planning advocates can use our toolkit to encourage leaders to think family planning:
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.