MCHIP brings health services closer to the pastoralist community in East Pokot
East Pokot, Kenya—At Kolowah Medical Center, Sarah Chebil and her two colleagues quickly pack up an ambulance for the 42-kilometer journey to Chesotin, an isolated village deep in the heart of East Pokot. There, they will offer medical services to a group of mothers and their children who are often hard to reach due to their pastoralist nature.
It is 10:00 a.m. and if the medical center staff are to meet the objectives of the day, they need to work quickly. Their route to Chesotin is rough, driving over rocks in the unforgiving heat of East Pokot. After two hours, the team finally arrives at Chesotin and starts unloading the vehicle. The mobile clinic, set up around a dried-up riverbed, is not your regular clinic. Sparse trees provide shelter, while clients sit on a scattering of rocks to wait their turn.
The driver honks the vehicle’s horn continuously for a minute to alert those on the way that medical help has arrived. Women in their colorful lesos (shawls), cradling their babies, gather at the camp, where the help they have been waiting for has finally arrived. Some of these women, pregnant and leading small children, have walked for over 12 hours to get here.
For the last 18 months, Jhpiego has been working in East Pokot under the U.S. Agency for International Development’s flagship Maternal and Child Health Integrated Program (MCHIP) to improve the health of women and their families. In this area, where paved roads are scarce and motorized transport is hard to come by, medical outreach has proved to be the best alternative for providing health services to people.
“Most of the residents in this area are nomadic, so they are always on the move,” says Johnston Koskei, the assistant chief in the area. “The only way we can ensure that they have access to health care is by bringing the services closer to them.”
At the site of the mobile clinic, more than 50 women have gathered. The nurse-in-charge takes out a large black book and starts the registration process while the small children are lined up for deworming. As the rest of the team sets up different stations, Chebil gives a general health talk touching on the benefits of immunization and exclusive breastfeeding. She tells the mothers about malaria and nutrition for themselves and their babies. Every so often, the mothers break out in laughter and questions are exchanged.
Where there is no doctor…
Koskei says that to alert the residents about an upcoming medical outreach, the local administration works together with community health workers to spread the word door to door in the villages and in local markets. In today’s outreach, some of the children are as old as five and have never been vaccinated. Koskei attributes this to distance and lack of access. On this day, the patients will receive a variety of services, including immunization, screening for malnutrition, and nutrition advice for pregnant and lactating mothers. Minor ailments will be treated and mosquito nets will be given to expectant mothers and the parents of children under the age of one.
Reaching Every District
In Kenya, Jhpiego is building the capacity of health workers to provide focused antenatal care by integrating a broad range of services, including prevention and treatment of malaria in pregnancy, prevention of mother-to-child transmission of HIV, immunization and nutrition. According to a 2013 baseline survey conducted in Kenya on immunization coverage, East Pokot was identified as one of the sub-counties with the lowest immunization coverage for all vaccines. The problem was attributed to inadequate vaccine storage capacity, few immunizing facilities (less than half of all facilities), lack of knowledge and skills in vaccine management, poor staffing and minimal outreach services. Since then, MCHIP has been working with health facilities to implement the Reaching Every District (RED) approach to improve immunization coverage in the area. Under RED, MCHIP works with health facilities to prepare micro-plans that enable them to map out the areas that need outreach services based on the number of unvaccinated children. So far, the immunization coverage in the area has risen from 31 percent to 48 percent.
Koskei is optimistic about the future of health in his district and hopeful that the number of people accessing health care services through this kind of outreach will grow: “If we can get more people to come to the clinic, we will reduce our mortality rates. That is what I want to see.”