Kenya

Small NGO set up by group involved in motorcycle Grand Prix

Riders responsible for travelling to rural communities and providing services- health education, disease surveillance, immunisations, HIV counselling

Collaborative- operate across number of countries- managed by local people so skills stay in country

Practical and appropriate solution to widespread global health problem

Riders system- make sure partners always have well maintained ambulance- staffed by trained driver

Manage- 36 car ambulances- 3x more patients referred to hospitals by ambulances

3 million people each year have interactions with health workers

Motorcycle- cheaper to buy and run, cover more challenging terrain- ride in rough weather all year

Single track vehicle- most roads narrow and animal tracks hence ideal

Transport blood samples for testing- ensures medical samples are taken from patients at health centres and transported to labs quickly- results promptly returned

Goal- reduce turnaround time between sample collection and return of results to facility- enables patients to begin treatment earlier- more accurate consistent monitoring

Preventive Maintenance-

Replace vehicle parts at regular intervals to avoid breakdowns- keeps fleets running in better condition

Technicians bring our services near to where partner works

Travel to convenient location to conduct regular maintenance saving time and money

Training of vehicle users- road accidents- one of biggest cause of deaths across Africa

Training School- ‘international Academy of vehicle management (IAVM)- branches in Kenya and Zimbabwe

Why train? Increase in staff safety and lifespan of vehicle, decrease in accidents and maintenance costs

 Feed the future 

35% of children have stunted growth

75% of population live in the rural areas

4.6% annual GDP growth

75% make part of their living in agricutlure- sector accounts for more than half of countrys domestic product

However sector is stagnating whilst population is rising- challenges to food security

20% of Kenyans land is suitable for farming. Farmers work without updated technology

Feed the future making key investments to:

Enhance food secutiry and improve nutritional status of woman

1996- registered as independent NGO in UK

Work with ministries of health, international, NGOs and private sectors

Over 60% population live in rural locations- 14% road networks paved

Characterised by hills, mud and clay tracks

Employed 275 people

Maintained 1400 vehicles

Enabled workers to reach 10.8 million

Each week- extra 20,000 people in Kenya reached- able to travel to more isolated areas- spend double the amount of time in communities- do not waste time travelling between villages

Riders began working in Kenya with African Infectious Diseases Village Clinics (AIDVCs)- expanded into western Kenya in 2007

Operates a grassroots initiative- provides outreach health workers from local community based organisations with the transportation they require to do their jobs

Started- 2002

Staff- 8

Vehicles managed- 77

Km per month- 56

Population covered- 5 million

People lived in villages so far apart- nurses couldn’t reach them with healthcare

For a vehicle to run properly- must be serviced especially when used in hostile envir

Transport affects everything, without- development impossible

Making collections at events e.g. British Grand Prix in UK- able to raise funds to support

As transport was never factored into the costings of healthcare, without reliable system- millions of pounds invested in vaccines, drugs, condoms and trained health professionals- wasted

Improved health care access for 12 million people across Africa

3 million men, woman and children now have access to lab services at primary level

1 public health worker responsible for 20,000 people over area of 200 miles- mobility- vital

30,000 children under 5 die everyday across developing world from preventable or treatable diseases

Riders Aims:

1.     Enable workers to reach those in rural areas

2.     Establish sustainable transport system

3.     Develop and support vehicle maintenance

Develop a self-sustaining culture of maintenance

Workers gone from spending 2 days in field each week to 4- possible as their travel time has been cut from 4 hours each day to 1- still able to reach 80km away vs. 20km before

WHO recommended 14 nurses for every 4000 residents. Kenya has 7. Cost 113 billion to KSH to train the 51,000 nurses to meet recommendation

Riders mobilised workers from local grassroots organisations-provide essential support services- workers able to see over 7x more as travel 4x further- 175km away

Riders able to reach target communities more to support patients early recognition of symptoms reducing the stigma prompting them to seek medical help

Workers spend more time identifying new cases and outbreaks of disease making referrals to health centres- limits spread

Riders visit average of 10 villages per week, spend 4 hours a day working in rural communities 

Reliable transport system- workers have capacity to provide reliable and consistent follow up care

Managed transport- encourages uptake of contracepetion uses

Gambia- no outreach clinic cancelled due to riders vs 32% before

Zimbabwe- turnaround for lab results from 8 to 3 days

Each week in Kenya- extra 20,000 people reached

Programmes:

Mobilising community health workers- a grassroots programme that provides outreach health workers from local community groups with the transportation they need to do their jobs

FLEP- grassroots organisation- works with community groups to raise awareness of HIV and offers support

Training- International academy of vehicle managment-registered driving school that offers trianing in safe driving and preventative vehicle maintenence

Riders facilitate support groups, conduct counselling, offer testing and ensure patients adhere to treatment

Riders can spend double the amount of time in communities having a motorcycle. 1 hour vs 5 hours now

New project testing- using GPS maps and tracking the coverage of the outreach health workers

Low income, food deficient country

Kenyas postiion on the human development index has dropped from 134/173 in 2002 to 154 in 2005

58% below poverty line

Economic productivity is unevenly distributed between central areas and the sparesely populated peripheral areas

Home to 238,000 refugees and 360,000 displaced people from Sudan

HIV prevalence rate reduced from 10% to 6.7%- still major health concern- high amongst girls and migrant workers

Sanitation and safe drinking water is 42%

Drought prone areas- 50,000 malnourished children in the 27 districts

70% urban dwellers have access to health facilities vs 30% rural population

High maternal rate due to - lack of skilled attendence at birth, HIV, poor indeaquate access to services due to geographical barriers

30% kenyans have access to medicine

2004- total expenditure on health was 4% of the GDP

Youthful population- 42% vs Elderly 5%

51% doctors leave Kenya vs 20% in SA

HIV responsible for 30% of all deaths

Non communicable diseases on the increase

Diarrhoeal diseases- one of major causes of child mortality- in areas of shortage in dirnking water, sanitation, malnutrition

National long term development blue print that aims to transform Kenya into newly industrialising middle income country providing high quality of life to all by 2030 in a clean secure environment

3 Key pillars- Economic, Social, Political

Economic- aims to achieve average growth rate of 10% per year and sustaining same till 2030

Social- seeks to engender fair social development in a clean and secure environment

Political- aims to realise an issue based, people centred accountable democratic system

Dream

Want a kenya that is able to adequately feed itself, the world and give jobs

Want a Kenya with good network of roads that enhance business within country

Want a Kenya where children are educated by well trained teachers

Want a Kenya where all can afford to go to well-equipped hospitals

Second medium term plan

Deliver accelerated economic growth, higher living standards, better education and health care, increased job creation especially for youths, commercialized agriculture providing higher rural incomes and affordable food

All necessary to address challenges of poverty, joblessness and inequality 

Strengthen economy- gov spending on expansion and modernisation of railways, roads, ports, airports, energy, water

The gov will enhance economy by devoting more to infrastructure

In order to meet goals of job creation, priority will be accorded to programmes targeting training and apprenticeships to meet the demand for human resource skills required to transform Kenyan economy central to medium plan

Gov will strengthen youth employment through training enabling them to require skills and engage in productive employment on their own or suppliers to larger enterprises in public or private sectors

Survey report 2014

Total number of persons engaged in formal and informal sectors increased from 12 million (2012) to 13 million (2013)- 750,000 new jobs

GDP expanded by 4.7% (2013) to 4.6% (2012) supported by infrastructual development

Transport and communication increased from 4.7% (2012) to 6% (2013)

Growth in agriculutral sectors decelerated in 2013 to 2.9% from 4.2% in 2012 due to inadequate rainfall

Response to repeated droughts, Feed the future is collaborating with other USAID programs in Kenya to improve resilience of vulnerable populations in arid areas

Trained more than 11,000 community health workers on integrating nutrition into visits with families

Works with Kenyans to improve health, education and food security

USAID provided professional learning opportunities to 6000 educators- 316,000 children benefitted from new teaching methods and the development of up to date learning materials. Also  reach out to children who have been excluded from education system

Children do not have the skills or networks to access employment opportunities- USAID with the Kenyan Gov trying to scale up solutions- Youth program empowered 1 million young people- once exculded to now working with gov and private sectors. 

USAID and Kenyan Gov- Kenyans have increased access to HIV prevention and treatment and care services- 490,000 on anti retroviral therapy by the end of 2011

USAIDS support to countrys fight against TB ensures drugs are delivered to health facilities- support has helped Kenya to pass the WHOs TB targets of treating 85% of patients

It will take time and commitment to mobilise the necesssary resources, train the required people and establish the needed infrastructure

Challenge- rapid population growth- the number of people in demand for health, education etc is increasing- means the amount of resources and infrastructure required to meet MDGs is increasing

Family planning can reduce population growth and make achieving MDGs more affordable reducing child mortality

High rates of population growth- high fertility due to lack of family planning- kenyan woman on average have 5 children each. 25% of woman want to limit births but are not using any method of family planning

Family planning- result in fewer children requiring education

helps to reduce number of high risk pregnancies that result in maternal and IM

Kenya could be expected to reduce 3.9 million unintended pregnancies, 14,000 maternal deaths and 434,000 child deaths by target date in 2015

Coolest places in central around Mt Kenya- T decrease by 1.5

Colder areas coincide with highest rainfall, over 2000m annually on the mountain

Areas of high population density found in cooler provinces of central and Nairobi

Western- highest population 600+per sq km

High population around Mombassa on the coast, T= high, influnece of ITCZ and monsoon climate given rise to high levels of rainfall. Region benefits from cool sea breezes- high tourist trade

Highest population where higher levels of rainfall and T is cooler- links to reliance on farming- needs more moderate conditions. Areas coincide with mountainous regions

Areas of highest population density are highest poverty levels- too many people for the resources. In western areas of highest rainfall- people suffer from flooding where lose everything

Advantages and Disadvantages of rotating expat programme:

+ves:

increase number of health workers, expats will bring new skills which they can share with colleagues. They may be positive role models for local people encouraging them to stay in country

-vs:

Constant change makes it hard to form relationships between patient and doctor, workers may not speak local dialects making communications difficult

Poverty- people have to rely on ecosystem for fuel wood- deforestation. People hunt for food even in national parks. Lack of funds for sanitation- waterways become polluted- diseases

There has been improved managment around Mt Kenya- improving the condition of the forest

Rural environment issues:

Forests are degraded to feed population- forests important features of water supply

Growth of city puts pressure on Nariobi national park

Mt Kenya- intense population growth around mountain

Urban environment issues:

North- growing rapidly to a city of 3 million

Slum dwellers in Kiberia have ruined rivers due to poor sanitiation

Poor air quality, vehicle pollution

15000 tonnes of waste generated in N per day

Strengths:

Education likely to reach target- HIV teaching in school curriculum. Poverty decreased by 20% in 2000. Reduce HIV by 2014 (2007- 8.4%- 6.3%). Increased sanitation

Weakenesses:

Child mortality, Maternal mortality, Indeadeqate infrastructure, private health care- noone can afford, distribution inequalities- 70% urban vs 30% rural

Opportunities:

Inclusion of HIV education in school curriculum, increased investment in green energy, mobile network coverage increased (49% - 68%) 2009-2011, Invest in family planning and transport maintenence

Threats:

Non communicable diseases on rise, poverty, lack of health facilities in arid areas, dependent on foreign aid

Land- 570,000 sq km

Water- 11,000 sq km

Low plains rise to central highliands bisected by Great Rift Valley; fertile plateau in west

197 airports- 16 paved runways vs 181 unpaved

Roads- 160,000km- paved -11,000, unpaved- 150,000

Mount Kenya- 5200m

Kilimenjaro- 5895m

Climate varies from tropical along coast to arid inland- due to topography 

Most PPT where highest rates of poverty and population are

Unequal distribution- N, E dry S, W wet

Relief in highest areas

Mombassa- high relief- ITCZ, low pressure- air rising- rainfall- Highest use of malaria nets found

Malaria found in high precipitaed areas- mosquitos like warm humid climates

Arable land- 9.5%

Water pollution from urban and industrial wastes- degradation of water quality from increased use of pesticides and fertilisers- deforestation, soil erosion, poaching

Highest % of cropland in highest relief, PPT, poverty and population areas

58% below poverty line- $1.46 a day in urban areas

Kenya failed to sustain economic growth and complete its demographic transition- population expanded turning country into poor resource one

Poverty in rural areas and city slums- HIV aids orphaned 1 million children, conflicts, domestic violence and prostitution

Rural economy dependent on substience farming- 75% countrys agricutlure output

Rural farmers depend on rain- erratic weather patterns and effects of climate change have affected this

Highest rates in West where high population density, food security, presence of malaria, precipitation