Where families and their animals are treated in one clinic

By Angela Oketch

Reporter: Nation Media Group

What you need to know:

• Contraceptive uptake in Turkana is at 18 per cent against a national average of 59 per cent.
• Women have to seek permission from their husbands to use family planning.
• Hospital deliveries increased from 33 per cent in 2016 to 65 per cent due to Kimormor.
• The programme, implemented on a quarterly basis, identifies a central point where many kraal villages can meet.

Women are seen from a distance with their toddlers. Esther Lopuyo is carrying her two-month-old. Several women are behind her with babies strapped to their backs.

From Edot village, the women have trekked for five kilometres in the scorching sun to the Sasaak Edot water point area for clinical checkups, immunisation and birth control methods.

At the water point, the men have already arrived with their herds of cows, camels and sheep. The men have not escorted their women to the clinic, but they are here because they want their animals to be given water, drugs and to get vaccinated. The veterinary clinic is just next to the health clinic.

Residents are seen arriving in small numbers from different directions that are far apart. They are here for the Kimormor clinic. Kimormor is a Turkana word that means bringing all the services together under one roof.

In the past, Esther would stay for even a year without seeing her husband who is a nomadic pastoralist. He would move from one area to the other in search of pasture and water. This is normally the life of many men in Turkana County which apparently has taken a toll on families’ health.

Given the distance from their homes to health facilities, women are used to giving birth at home. Some are assisted by traditional health workers.

Unfortunately, others give birth on their own when their husbands are away and this has been blamed for the rise in maternal and child deaths in the county. Children born to a mother in Turkana are twice as likely to die before their fifth birthday compared with the national average. Families here are unlikely to go to the hospital for care.

Nanok Kamaret, Esther’s husband, says most of his children have not received vaccination. Of his 10 children, only the young ones benefited from Kimormor. The rest are past the age of getting vaccinated.

Kamaret is always busy with his cattle and the health of his family was not a priority previously. He arrives at Kimormor with a herd of 5,000 animals (goats, camels, cows and donkeys).

Before the immunisation of their child, a health worker holds a session with both parents and informs them of the importance of vaccination and family planning to space the birth of their children.

When asked whether she had heard of family planning methods and their benefits, Esther says she will only agree to start on any methods after getting a go-ahead from her husband.

To her surprise, after a five-minute discussion with the health worker, Kamaret agrees to have Esther on a three-year implant. By the time she will be going for her second method, her youngest child will be four years old.

“All my children are one-year apart and they are always sickly. I give birth yearly. At least I am going to get a breather,” she says. In Turkana, a woman gives birth to seven children on average and only 10 per cent of women of reproductive age (15 to 49 years) use any contraceptive (whether traditional or modern).

Although, uptake of modern contraceptives is improving in the county, the numbers are still rather low at 18 per cent against a national average of 59 per cent. Some parts of the county, like the northern side, have an uptake of one per cent.

Counties with high poverty levels like Turkana have little or no access to contraceptives. This, in turn, contributes to poor health indicators for mothers who cannot space births and their children.

Dr Gilchrist Lokoel, the Director of Medical Services, tells HealthyNation that women have to seek permission from their husbands to use family planning, which most men do not support. They say it is a ploy to sterilise women.

However, programmes like Kimormor are changing the narrative given the fact that residents are attending the clinics as a family and the men are told of the importance of family planning.

“From malnutrition, insecurity, ravages of HIV/Aids, floods and malaria outbreaks, Turkana is a laboratory of disaster,” says Dr Lokoel. “The fixed health facility model was the wrong method.”

Eighty per cent of Turkana’s population is 100 per cent pastoralist, making it necessary to programme healthcare with such livelihoods in mind, he adds.

“Instead of the sick person going to seek care in a facility, the health provider goes to the person to provide the services,” says Dr Lokoel.
This is what Kimormor has done through with the help of donors, the county government and other partners. “There is a big confluence between livestock, human and health care. If you want to win the heart of a pastoralist, take care of his livestock, provide livestock immunisation and give them water,” he says.

He says the future is in these health innovations including Kimormor because for a long time, they could not improve indicators. “When people come for Kimormor, mothers are taken care of, mothers receive ANC care, are dewormed, get family planning methods and children receive nutrition checkups, immunisation records are checked and animals are immunized. In addition, birth certificates and IDs are issued. It is like a Huduma Centre. It is a one-stop shop,” he adds.

The programme has also brought about cross border peace.

In 2018, Turkana topped the country with 84 per cent of children being fully immunised courtesy of the Kimormor programme. This means for every 100 children only two are not immunised.

Hospital deliveries increased from 33 per cent in 2016 to 65 per cent. There is an average of 350 deliveries per month compared to 150 in 2016. The same is replicated at sub-county hospitals spread across the region.

Family planning coverage was at eight per cent in 2013 and because of the Kimormor strategy, it shot to 18 per cent in 2018.

Turkana has been rated as one of the worst counties in terms of maternal mortalities. The county is losing 1,536 mothers per 100,000 live births but with the innovations like Kimormor the county is recording lower deaths. “If we invest in innovations like Kimormor, then I think Vision 2030 would be much nearer than we anticipated,” says Dr Lokoel.

At the Kimormor, two of Esther’s children were given birth certificates and she got a waiting card for her national identification card.
“If we could be getting such services weekly, then we will improve our healthcare system. The reason I rarely go to the hospital is because I have to walk 50km to get there. Also, most services are charged while at the Kimormor everything is given for free. I am happy with this plan,” she tells HealthyNation at the water point.

Immediately after the health care services and checkups Kamaret has his herds vaccinated, he takes their drugs, gives them water and the family heads back home.

“Had it not been for this clinic, vaccinating a herd of 1,000 animals, would have cost me Sh10,000. Imagine vaccinating 5,000. I could not have it. I have lost some of my animals due to lack of money for drugs. I am happy that my family has been checked and my wife has been put on a family planning method,” says Kamaret.

“Getting nomadic men to health facilities or involved in their family’s lives is always a challenge, even though it is always advisable that they take part for their own health and to the benefit of their loved ones,” says Dr Lokoel.

In another part of Turkana in Kachapan village, we meet 62-year-old Albert Ngikadolio, a father of 14. He has never stepped into a health facility for any treatment when he is unwell. His family depends on traditional medicines, brewed locally.

Until Kimormor, his three wives had no idea about family planning. They depended on the head of the house to give direction on whether they should go for the methods or not. However, Ngikadolio did not understand family planning, therefore could not decide.

All his children have never been immunized. Apart from his two youngest, they do not have birth certificates. The young ones benefited from Kimormor, an initiative by the Turkana government and Afya Timiza.

For the two days that the clinic was held in Loima Sub-County, several children were given birth certificates, 450 were immunised, hundreds of women got their preferred family planning methods and thousands of cattle were vaccinated.

“I got my ID, which I applied for years back. I also got hold of an NHIF card for the first time in my life. My last wife had her family planning method,” says Ngikadolio.

This programme is the answer to a public health problem in the county that has for long baffled health workers, donors and county health officials.

Turkana is one of the counties with the highest number of donors funding various health programmes in the country. However, the data never changes. It is one of the problems the county has to ponder day and night.

But now Kimormor seems to have provided the answer.

The programme, implemented on a quarterly basis, identifies a central point where many kraal villages can meet.

A week before the Kimormor outreach day, the officers go around the village informing the residents of the designated place, the services that will be offered, their importance and how they will benefit. Hundreds of residents attend the clinics.

On the Kimormor day at exactly 3am, a convoy of vehicles leaves Lodwar for the water point, given the migratory routes and rocky terrain, it takes us four hours to reach the water point. On getting there, seven tents and tables are erected in different places for different services.

From 7am, the team is already on the ground, they offer the services until 5pm. The leftovers, including the vaccines and medicine, are packed and the team heads to the nearest health facility where they will spend a night in readiness for the next clinic.

The families go back to their settlements. It would take them another three months to come back to the same location.

Explaining to the HealthyNation how the programme came about Anthony Arasio, Amref Health Africa technical advisor, says the idea was informed by the experience of other health services that Amref had implemented for close to 40 years in the county dealing with pastoral communities in hard-to-reach areas.

Arasio says they approached the decision makers, who told them that the needs of the people were not well captured since the services were not integrated. They called for a one-stop shop.

“We were told that the livestock had to come first because herders always migrated in search of water, pasture and security,” says Arasio.
After setting up of structures and training of stakeholders, the funding stopped and the county picked up from where Afya Timiza left.

The World Bank funded the project to a tune of Sh35 million. The county contributed Sh5 million.

“Through the structures that we had put in place, Kimormor is being implemented by the county on a quarterly basis and within a year, most sub-counties are covered,” he says.

The project was rolled out in 2017 through the USAid Afya Timiza funding at Sh2 million per quarter for three years in three sub-counties starting in Kibish Sub-County. In the first two quarters, there were notable results in terms of child health immunisation from 12 per cent to 40 per cent in the first year. In the second year, it shot to 60 per cent. 

According to data from Afya Timiza on Kimormor in Kibish 2018, a total of 1,500 mothers attended an antenatal clinic with over 500 going until their fourth ANC visit. “It means the women are likely to give birth in facilities and to healthy children,” says Arasio.

About 10,800 people got health services, 10,000 nutrition screening, with over 4,000 children getting all their vaccinations.

On animal health, 40,000 animals were vaccinated, over 100,000 sheep and goats were dewormed and about 2,000 livestock were treated for pneumonia conditions.

On social amenities, about 2,500 people got their IDs, 500 births were registered and birth certificates issued and 500 others got the NHIF card.

“The future is in Kimormor like ideas,” says Dr Lokoel.

The article was first published on Nation Africa