Connecting Cultural and Formal Health Systems to Increase Uptake of Health Services among Nomadic Pastoralists in Kenya

Summary:

Health care access disparities are more pronounced among the hard to reach nomadic pastoralists. In Turkana County, infant mortality and under five mortality rates are around two times higher than national average. Family planning coverage is one fifth of national average, and antenatal care (ANC) of at least four visits is below 50%. Kimormor cross-sector outreach model is used by the USAID funded AFYA TIMIZA project to address identified health challenges. Kimormor means 'putting things in one pot' in Turkana language. This is a 'one-stop shop' approach combining cultural leadership with community-led advocacy, social mobilization and communication focused on BCC together with Digisomo Talking Books Innovation. This is led through traditional Turkana Emurons (seers) drawing on the concept of Arwon (heroism), which taps into the willingness of community members to stand out as defenders. But, with a twist, an Arwon is not just a warrior fighting outsiders and protects the herds he is also aware of many other threats within the community that can afflict family health. Over one year, health care access has improved. Using the interrupted time series design with comparison group, results show new ANC visits increased by 90%, and completion of four ANC visits increased by 129%. Skilled birth attendance increased by 64% and full immunization of children increased by 76%. 17 Emurons have been engaged and 10,840 nomadic community members reached with SBC and health services. Kimormor enhanced SBC outcomes in the communities and strengthened linkage between informal and formal systems.

Background/Objectives:

Disparities in health care access are more pronounced among the hard to reach nomadic pastoralist communities. In Turkana County, negative impacts on women and children are severe. Infant mortality and under five mortality rates are around two times higher than the national average. Family planning coverage is one fifth of the national average, and antenatal care of at least four visits is below 50 percent. Description of Intervention and/or Methods/Design: A cross-sector 'one-stop shop' outreach strategy was followed. Entitled Kimormor, which means 'putting things in one pot', the approach combines cultural leadership collaboration with community-led traditional advocacy, social mobilization and communication focused on behavior change in conjunction with Digisomo Talking Books Innovation. The process is led through traditional Turkana Emurons (seers) drawing on the concept of Arwon (heroism), which taps into the willingness of members of the communities in Turkana County to stand out as defenders. But, with a twist, an Arwon is not just a warrior who fights outsiders and keeps the herds safe he also knows that there are also many threats within the community that can afflict a family's health. This fits with the slogan 'Ushujaa ni kulinda afya ya jamii' (heroism is protecting the family's health).

Results/Lessons Learned:

Access to health care over one year increased markedly. New antenatal care visits increased by 90 percent, and completion of four antenatal care visits increased by 129 percent. Skilled birth attendance increased by 64 percent, and full immunization of children increased by 76 percent. High reach of the communication components including utilization of the Digisomo Talking Books device was achieved. Service demand was improved through engagement with community health volunteers. The Kimormor approach has been included in the Turkana County Integrated Development Plan. 17 Emurons have been engaged and 10,840 nomadic community members reached with health messages and services. Kimormor is an innovative cost-effective integrated service delivery model for the hard to reach nomadic pastoralist communities with potential to address multiple challenges and enhance scale up of SBC interventions and services delivery and utilization. Kimormor enhanced SBC outcomes in the communities and strengthened the linkage between informal and formal systems.

Discussion/Implications for the Field:

Cross sector SBC models enhance social and behavior change outcomes in the communities and strengthens linkage between informal and formal systems. Such models need to be flexible and adapt to the cultural context of the underserved hard to reach populations in order to address socio-cultural and gender norms that are barriers to access and utilization of health services.

Abstract submitted by:

Catherine Lengewa - Centre for Behaviour Change and Communication (CBCC)
Gilbert Wangalwa - Afya Timiza
Mark Lominito - Afya Timiza
Anthony Arasio - Afya Timiza