The Road Less Travelled (TRLT) is an integrated maternal and child health and community development project working with nomadic pastoralist communities in Kenya and Ethiopia. The project is led by Anglican Overseas Aid in Kenya, partnering with the Mother’s Union of the Anglican Church of Kenya and the Maasai and Samburu nomadic pastoralist communities in Laikipia and Samburu counties. TRLT’s holistic approach focuses on improving core maternal and child health (MCH) outcomes, and applies methods to address education and literacy, as well as improve access to water, food security, and sustainable livelihoods. The desire to achieve health equity through the empowerment of women underpins all activity. Three years on it’s exciting to see people’s lives changing for the better in Longewan Ranch in Samburu County, especially for women.
Understanding women’s empowerment
Transforming women’s lives in a patriarchal environment is a difficult but essential challenge for TRLT. Empowerment is not a simple task; it is a multi-faceted process. Adequate support needs to be in place before starting the process. A sense of belonging and increased self-esteem are factors that contribute to a woman’s status in community. Her respect subsequently grows within families, communities and the broader society. TRLT, through its partnerships, provides the necessary support, information, resources, and creativity to allow women to find solutions to their own problems.
Challenges for women’s health
Initiating the process to improve women’s authority, one cannot ignore the cultural, social and environmental milieu which can inhibit progress. In Samburu, women traditionally birth at home away from qualified nurses. There are many constraints to attending clinics, including lack of nurses, distance, refusal by husbands, and women’s own beliefs that delivering at a clinic is a sign of cowardice.
Antonella Leakono has been the only nursing officer in charge of Longewan Dispensary for five years. As a Samburu woman, she recognises the need to invest in community health programs to achieve better health over the long haul for the people of her community.
“The biggest child health issues in this area are malnutrition, pneumonia, and diarrhea,” Antonella explains. “For women of reproductive age, it is anemia and infections related to giving birth at home.”
Causes of infections can include the use of unsterilised instruments during the delivery such as a knife for cutting the umbilical cord. Raising awareness on MCH remains a challenge, an almost impossible task for one Ministry of Health staff member, like Antonella, to tackle on her own.
Providing support: Instigating change
At the frontline of change are community health workers (CHWs) who have been trained collaboratively by TRLT and the Ministry of Health to provide frontline health services. Although the 18 Longewan CHWs do not have the same qualifications of a community health nurse, these volunteers spend approximately six hours per day, three days per week, visiting and caring for families, whilst also looking after their own. In one month, the 18 CHWs visit up to 248 households, and provided community members with pain killers, vitamins such as zinc, and oral rehydration solutions.
Carolin, the TRLT link person who has been trained as a CHW, explains that: “We educate women on importance of visiting clinics and on immunisations. Through trainings in the area of maternal neonatal child health, nutrition and first aid, we have the skills to identify danger signs such as bleeding during pregnancies, if a child is malnourished or if a child is not breastfeeding properly”. The work of the CHWs make significant contributions across many of TRLT’s goals in improving women’s health through women’s empowerment in the region. Yet their impact is far greater than just basic health services. They have an effect on community socio-economic standards generally, along with influencing the esteem with which women are regarded.
Empowerment through education and training
In Samburu, only 15% of women can read and write in Maa and/or Swahili. Hosea and Cecilia are two CHWs in Longewan who have started to facilitate free adult literacy and numeracy classes for men and women. Currently, 24 women and three men attend the classes. Literacy plays an important role in determining women’s health, and their ability to seek healthcare. Improved literacy levels expand women’s access to knowledge, economic resources, and political power.
TRLT, in partnership with Equity Bank, have organised business training and financial management classes to improve men and women’s ability to save and better manage their assets. Poverty is intrinsically linked with poor health as it forces people to live in inadequate environments. By empowering women with the skills to manage their finances, it makes them less dependent on their husbands, and more likely to financially invest in their family’s health.
Identifying child malnutrition and anemia in pregnant women as a need, CHWs have also been involved in broadening the diet of community members through kitchen garden awareness training conducted in partnership with the Department of Agriculture. TRLT’s seed bank initiative encourages community members to produce their own food, whilst supporting others in their community. TRLT provides start up seeds from which community members grow their own crops. Once the crop has gone to seed, they are expected to keep a proportion for their next harvest, whilst distributing the remaining to others who can then start their own garden.
Saving Lives, Healthy Children, Improved Economy
In combination the CHW activities have an impact far greater than each individual task. Encouraging women to go to clinics for checks and to birth reduces risk of infection and even mortality. Improving diet, and working with the Ministry of Health on vaccination campaigns, leads to healthier children more resistant to debilitating diseases. Literacy education increases confidence and the ability to make and apply decisions that affect mothers’ lives. Starting-up small-scale economic activities generates disposable income to be spent on improving family well being. Along with reducing demand, and associated costs, on curative health services, the total effect contributes to the social health and well being, improves productivity adding to societal wealth, and accordingly strengthen the entire community.
The road ahead: Working together with the community health workers
The cohesion and commitment of these CHWs is palpable. They are being seen as community leaders, and regarded by their peers, both male and female, as equals because of the competencies and authority they provide. Moreover, the carry on effects of their work – empowering women and their communities through an integrated maternal and child health approach – is invaluable.
“People want to live a good life, so they see the value of our work in the community,” Cecilia explains. “The level of knowledge in the community is slowly increasing. People are beginning to change.”