Innovation and Grit to Enhance Equitable Access to Health Services

Mzee Learti Lentoro is the head of a household of 36 members.

He is a nomadic pastoralist from Marti Elepareu Catchment Area of Samburu East, Samburu County. This region is characterized by harsh weather conditions that include frequent droughts and floods that limit the availability of water and food. Health facilities in this county are limited (77 for a population of 223, 947); and the existing ones are either understaffed, or lack qualified medical personnel. The only and closest health facility in Mzee Lentoro’s area is 52 kilometres away.

Now in his late fifties, Mzee Lentoro married three wives. His first wife recently succumbed to a painful death as a result of obstructed labour and haemorrhage while delivering her 13^th child. The delivery took place at home without any skilled assistance. The child did not survive either.

His 30 year old second wife Leshasami has delivered 12 children and experienced three miscarriages. Every time she is pregnant, she is bedridden and suffers constant migraines. To ease the burden during her last pregnancy, her husband opted for her to terminate the pregnancy using traditional herbs but this was not successful. She delivered her 12^th child at home with the help of her aunt. Leshasami is now seeking treatment for endometriosis, as well as receiving family planning services.

Mzee Learti’s third wife is 24 years old and recently had her fifth child who is now seven months old. Like all his other children, the seven month old child has only received some of the immunizations necessary for the development and wellbeing of any child.

Mzee, who has also adopted his late brother’s children, feels overwhelmed by his large family as he cannot sufficiently provide for their basic needs. He wishes he could continue enjoying his polygamous status without his wives having any more children.

Notwithstanding the culture of his patriarchal community, Mzee Learti has an intrinsic predisposition towards the health of his family. However, lack of knowledge is a major deterrent to reproductive health in his community.

“I did not know there was a way of controlling the number of children a woman can have and the intervals between births. I would not mind walking for several days to get to the nearest health facility if that is what it takes to get something that will help my wives get a break from child bearing,” says Mzee Learti.

Barriers to Health

Low literacy levels and cultural influences are not the only barriers to sexual reproductive health in nomadic pastoral communities. Access  to  health  care  in general  is  a  challenge  for rural and nomadic residents who are largely uninsured,  have a  greater difficulty  travelling  to  primary,  preventive,  prenatal,  and emergency  care  providers,  and have fewer health care resources to choose from.  Rural residents are often left without these services, increasing the physical barriers to quality and timely health care. The geographic variances in access have led to the realisation that different strategies to address health disparities have to be considered for these rural regions.

To aid in the attainment of Universal Health Care in Kenya and improve health coverage in Samburu County, the United States Agency for International Development’s (USAID) through Afya Timiza is implementing activities in the County with the aim of sustainably improving health outcomes for mothers, children and adolescents. To achieve this, the team makes use of the Camel Mobile Clinic Outreach to reach underserved populations with services including: family planning; antenatal care; postnatal care, immunisation; sexual reproductive health education; nutrition; and referrals.

The Camel Mobile Clinic

This strategy aims at reaching communities located at least 20 kilometres from the nearest health facility. It comprises of 12-14 camels loaded with medical supplies; seven camel handlers, one nurse; and three to five Community Owned Resource Persons (CORPs) or Community Health Volunteers (CHVs) who mobilize the community. The clinic outreach is rolled out in cycles – each cycle takes 24 to 30 days with the team spending three to four days with every community they come across.

The camels carry medical supplies for the community and food portions for the team. The teams trek along with the camels throughout the whole cycle.

So far the AFYA TIMIZA project has reached 1,942 children under five, 3,204 women of reproductive age and 1,719 adolescents aged 10-19 using the Camel Mobile Clinic.