turning a new leaf (2)
TRANSCRIPT
www.amref.org
TURNING A NEW LEAF
Ol Moran Integrated School Health Programme
Published in 2013 by AMREF Kenya
AMREF Kenya Country OfficeWilson Airport, Off Langata RoadP. O. Box 30125-00100 NairobiTel: + 254 20 699 4000Fax: + 254 20 600 6340/ 600 2531Email: [email protected]: www.amref.org
Writing: Stephen WakhuLayout and Design: Anthony Muninzwa
© AMREF 2013
TURNING A NEW LEAF
Lessons Learnt and Best Practices for School Health Project Among Pastoralist Communities in Olmoran Division, Laikipia West District
OLMORAN INTEGRATED SCHOOL HEALTH PROJECT
Table of Contents
ACKNOWLEDGEMENT...................................................................................................
BACKGROUND..................................................................................................................
PROJECT GOAL.................................................................................................................
BENEFICIARIES..................................................................................................................
CHALLENGES IN PROJECT IMPLEMENTATION.......................................................
PROJECT SUCCESSES.....................................................................................................
BEST PRACTICES..............................................................................................................
LESSONS LEARNT............................................................................................................
PICTORIAL..........................................................................................................................
2
3
5
5
8
10
14
26
30
1
ACKNOWLEDGEMENT
AMREF would like to acknowledge the generous support and funding of the Government of Navara through AMREF Spain towards the Integrated School Health project in Olmoran Division.
We would like to thank the Olmoran Division Primary schools for their support and participation in the Integrated School Health Project under the Trachoma programme. Their commitment to the project and the practice of proper hygiene across the division has immensely contributed to the success of the project.
We acknowledge our partners: the Ministry of the Education, Ministry of Public Health and Sanitation, Ministry of Water and Irrigation and the Provincial Administration for their support and commitment in the implementation of the School Health Project.
We also thank the Division Project Implementation Team (DPIT): the Area Education Officer, Edwin Omondi, District Public Health Office, Isaac Cherogon, Division Public Health Officer, Daniel Kahoro, Nurse-in-Charge Robert Wanjohi, Ag Division Officer, Francis Ngugi, Area Chief, Paul Maina and the Division Water Officer, George Waweru for tirelessly working with the schools and the community in the implementation of the project.
The success of the project is likewise attributed to the commendable work done by the Trachoma programme staff led by the Project Officer, Solomon Mwaniki and Project Assistant, Stephen Piko Dume.
We acknowledge the leadership and support of the AMREF Kenya Country Director, Dr Lennie Bazira S. Kyomuhangi, Dr Meshack Ndirangu, Deputy Country Director, Programme Manager, George Kimathi and Project Manager Francis Dikir.
Finally, we recognise and acknowledge efforts of the AMREF communication team in documenting, editing and layout of this publication.
2
BACKGROUNDThe Integrated School Health project was implemented in Laikipia West District, Olmoran Division, one of the 3 districts in Laikipia County. It has a population of 271,720 with 109,954 school going children. The district lies on the leeward side of Mt Kenya with relatively low rainfall and is generally arid.
Olmoran Division has a population of 18,474 (9,154 males and 9,320 females). It has 2 locations and 8 sub-locations and covers an area of
24,305km . The division is classified as an arid and semi-arid zone with a hot and dry climate. The division is inhabited mainly by the nomadic Maasai, Samburu, Turkana and Pokot communities, who keep large herds of cattle and seasonally migrate to other regions in search of pasture and water. With erratic, inadequate and unreliable rainfall ranging from 300mm to 800mm annually, livestock keeping is the main occupation and source of income. To add to the harsh climate characteristic of arid and semi-arid zones, cattle rustling reduces the livestock numbers making the population very poor.
A map of Laikipia West District
3
With a Human Development Index (HMI) of 0.536, Olmoran is one of the poorest divisions in Kenya and has a human poverty index of 41.3%, meaning a sizeable population lives on less than a dollar per day. The division's poverty is aggravated by lack of access to safe adequate water and proper sanitation facilities and poor hygiene practices, exposing the population to water and sanitation related diseases such as cholera, diarrhoea, dysentery and trachoma.
About 75% of the division's population has no access to proper health care, while infant immunisation coverage and ante-natal care attendance are below 20%. The proportion of the population with access to basic sanitation and portable water is estimated to be below 30%.
Olmoran division has one health centre and four dispensaries. Nevertheless, the harsh terrain in most parts of the division coupled with poor infrastructure present a challenge in accessing health care facilities that are located at a distance of over 10 kilometres apart.
Most of the schools in the division have dilapidated physical structures and lack basic amenities including water and sanitation facilities. The pit latrine to pupil ratio in the division is 1:20 compared to the recommended public health standard of 1:8 for every school. Limited availability of sanitary facilities poses a constant threat of disease outbreaks. The 12 month project by African Medical and Research Foundation (AMREF) under the Water Sanitation and Hygiene (WASH) Programme was funded by the Government of Navara through AMREF Spain to the tune of €87,200. The project aimed to improve the personal health and education of school going children by improving access to safe drinking water and basic sanitation across schools in the division.
The project hoped to help in the attainment of the United Nations Millennium Development Goal: Achieving universal primary education by 2015. The goal stipulates that children everywhere, boys and girls alike, will be able to complete a full course of primary schooling. Due to the high prevalence of water related diseases like diarrhoea, trachoma, typhoid fevers and intestinal parasites, school absenteeism in the division is a normal occurrence.
4
During the dry season, most school girls skip out on school and instead go in search of water. The school project hoped to improve the health and sanitation in the schools hence reducing the absenteeism rate.
The overall project objective was to improve the health status of the communities of Laikipia through the Personal Hygiene and Sanitation Education (PHASE) initiative particularly that of pre-primary school children. The project focused on hand washing, construction of toilets and the conservation of the environment by cleaning the school compound and its environs and tree planting in schools.
The primary target beneficiaries of this intervention were 4,041 primary school children; (2,081 boys and 1,923 girls) as an entry into the community. The water and sanitation facilities distributed and demonstrated in schools would be replicated by members of the communities who form the secondary beneficiaries in the area. The project's activities were carried out in 15 of the 17 schools in the division namely; Olmoran Primary, Survey Primary, Luoniek Primary, Mbombo Primary, Laikipia Ranching, Ndunyu Primary, Minjore Primary, Githima Primary, Mithuri Primary, Mutarakwa Primary, Kahuho Primary, Ol Mutunyi Primary, Mirango Primary, Gathanji Primary and Merigwet Primary with a total population of 2,993 pupils (1,503 boys and 1,490 girls).
Partners! Ministry of Education! Ministry of Public Health and Sanitation ! Ministry of Water and Irrigation! Provincial Administration
PROJECT GOAL
BENEFICIARIES
5
6
Peter Njoroge’s Story
7
CHILDREN AS CHANGE AGENTS
52 year old Peter Njoroge is father to Alice Njeri, a class six health club member at Survey Primary School. About a year ago, Peter recalls, he believed in the notion that all hygiene and sanitation responsibilities belonged to the woman, in his case to his wife Maureen Wangare.
This attitude was changed by an unexpected person, his daughter. In early 2012, his daughter came home from school with a deep-seated idea on how to improve hygiene and sanitation in their homestead. At first he was reluctant saying her ideas were a waste of time and space. But with the persistence of his daughter and his wife, a member of the school management committee, he began to soften his perception on hygiene and sanitation. He even recalls Maureen taking him to one of the hygiene and sanitation meetings at the school.
Peter saw the talking walls at the school and the messages they portrayed. He recalls that her daughter had written one of the messages on the wall of the toilet at home, “Please wash your hands after visiting the toilet”. He says his daughter even constructed a leaky tin and put it strategically near the toilet.
After the health meeting, Peter went back home and convened a meeting with his wife and daughter and apologised for not being keen on hygiene and sanitation, and he asked them to advise him on how he could help improve the hygiene and sanitation in their homestead.
Alice shared the activities of the school health club with her father. One of them being, the planting of trees in order to purify the air and conserve the environment. Peter took it upon himself to start planting trees around his home and even went a step further in encouraging his neighbours to conserve the environment by planting trees.
“With the knowledge I have received through my daughter and wife, I am determined to keep up the practice of proper hygiene and sanitation,” says a smiling Peter.
Toilet at Peter’s homestead with a hygiene message
CHALLENGES FACED DURING IMPLEMENTATION
VandalismVandalism of water tanks and the leaky tins were a major occurrence in the division. The division is inhabited with Maasai, Samburu, Turkana and Pokot communities who are nomadic pastoralists. The pastoralists in search of water end up destroying the water tanks and leaky tins since their livestock cannot drink water from the taps of the leaky tins and water tanks. They either break the water facilities to access the water or take away the leaky tins with them to use them as water containers.
To curb the vandalism, the schools were advised to lock their leaky tins in the staffroom at the end of the day and during the weekend. The schools' administration was also advised to work with the chiefs of the area to help them prevent the vandalism.
Harsh Weather and Poor TerrainThe school health project was implemented in four quarters and during the second quarter of the project, the division experienced heavy rainfall and access to some of the schools became a challenge hence delaying implementation of scheduled activities. To address
8
A vandalised tank at Merigwet Primary School
this, the project team reviewed the work plans and ensured that activities were implemented as planned.
Cultural BarriersThe school health project primary audience were the primary school children but one of the aims of the project was that the hygiene and sanitation practices introduced by the project would trickle down to the community level. This proved to be a challenge especially to the nomadic pastoralists in the division. Due to their migratory culture, they did not see the need of digging a pit latrine just to use it for a few months and leave. Some argued that they could not use the same pit latrine as their mothers and daughters as it was against their culture.
The community mobilization and health promotion sessions conducted in schools helped in raising awareness on the importance of latrines. The school children with the knowledge gained through the school health clubs also helped in passing the messages to their parents on the importance of good sanitation practices.
Inadequate ManpowerOne artisan trained by AMREF in a previous project was mandated with the construction of the toilets hence the construction of the toilets took longer than expected.
To curb this shortage, the project identified and trained artisans on the construction of latrines to ensure that, in future more artisans are available and construction of latrines does not take long.
9
PROJECT SUCCESSES
?Prevalence of water related diseases reduced from 94% in 2011 to 88% in the year 2012, a 6% reduction in diseases like typhoid fever, diarrhoea, amoebiasis and trachoma
?A 25% decrease in WASH related school absenteeism from 85% to 60%
?The Division's Kenya Certificate of Primary Education (KCPE) mean score improved from 224.15 points in 2011 to 240.54 in 2012
?Enrolment of primary school going children in the division increased by 500 pupils (240 girls and 260 boys) especially that of children from the pastoralist communities
?15 teachers and 15 PTA members were trained in each targeted school
?The distribution of 50 (20 litre) leaky tins in the 15 schools improved hand washing practices in the schools. 98% of the pupils across the schools now practice hand washing
?The construction of two toilets in every school improved the sanitation coverage in the school and reduced congestion of sanitation facilities
?94% of homesteads in the division now have a leaky tin strategically placed near a toilet and in use by the members of the homestead
10
A pupil washing hands at a Leaky Tin
11
A pupil washing hands at a Leaky Tin
Ventilated Improved Toilet (VIP)
12
Damaris Njeri’s Story
13
SEEKING A TYPHOID FREE COMMUNITYDamaris Njeri is a 60 year old small scale business woman and a PTA member of Mithuri Primary School. Njeri is an ambassador for hygiene and sanitation in her community. She says when she put up a leaky tin in her homestead, it created a lot of attention especially from the children and her neighbours wanted to know how to construct one and the importance of having one in their homes.
Damaris admit that at first it was hard to talk to her neighbours about hygiene and sanitation, since they had the notion that she thought they were all unhygienic. This did not deter her from sharing information on hygiene and sanitation with them. She informed them of the importance of leaky tins and even went an extra mile and constructed one for her neighbours.
Damaris says that the project brought healthy competition in the community. She recalls her neighbour feeling challenged with what Damaris was doing in the community, and she built a big tank in her home to harvest rain water providing clean water to a large number of homesteads in Mithuri community.
Damaris says that before the School Health Project, there was an outbreak of Trachoma because the pastoralists in the region did not see the significance of digging a toilet as they did not stay in the area for long.
They would defecate in the bush and this increased the number of flies in the area making trachoma and typhoid a normal occurrence. She was among those affected by typhoid but she can now say that after the training she received as a PTA member, she is sure that no one in her family will ever be affected by typhoid and she hopes the community will embrace the information she has shared with them and kick hygiene and water related diseases from the region.
BEST PRACTICES
During project implementation, the project rolled out a number of personal hygiene and sanitation education best practices including:
1. Talking Walls2. PHASE Kits3. Leaky Tins4. School Health Clubs5. Training of Teachers and PTA members
Talking WallsThese were murals put up in the 15 AMREF supported schools in the division with simple messages and drawings on proper hygiene and sanitation. The drawings were meant to appeal to the primary school pupils to embrace proper hygiene and sanitation in the community. The murals were drawn on permanent cement structures and for those schools that lacked cement structures the murals were drawn on the 5,000 litres tanks and toilets provided by the project.
The talking walls were a success because the pupils in the 15 schools could not only recite the messages on the drawn murals, but could also be seen practising the proper hygiene and sanitation as illustrated.
14
Talking Walls: Some of the murals drawn in the 15 targeted schools
15
PHASE KitsPHASE kits were distributed to all 15 schools to aid in learning about proper personal hygiene and sanitation. The schools, through their respective school health clubs, established a health library where these PHASE kits would be placed for easy access by all the pupils. The school health club patrons were given the mandate to ensure that the kits were read by all the pupils and the practices of proper personal hygiene and sanitation are practiced.
The PHASE kits contain information on water related diseases and how to prevent them, how to purify and treat drinking water, how to prepare food and food hygiene, how to properly use a pit latrine and how to protect the environment.
84% of the pupils in these schools could name, give causes and symptoms of water related diseases as indicated on the kits. It was rare to find a child walking barefoot as most pupils donned open rubber shoes famously known as 'Vuta Pumz'. The shoes are meant protect their feet especially when using the pit latrines.
16
PHASE Kitsdistributed in the schools
Leaky TinsThe leaky tin, an improvised water tap used for hand and face washing, has become a common sight in Olmoran division. The project supplied 50 leaky tins (an average of 3 per school) to the 15 schools and these were placed strategically near the school toilet to ensure that pupils washed their hands after visiting the toilet. 94% of homesteads in the division now have leaky tins strategically placed near the toilets across various homesteads.
With high poverty levels, erratic and inadequate rainfall in the region, leaky tins offer a cheap, easy to produce, easy to use, hygienic and economical solution for hand washing.
Leaky tins have proved to be an invaluable appendage in the fight against water related diseases such as trachoma and diarrhoea and a resounding success for the practice of proper hygiene and sanitation among school going children and communities at large.
17
Leaky Tin
School Health ClubsSchool health clubs were integrated into the project for the purpose of sustainability and continuity of proper hygiene and sanitation practices beyond the life of the project. A club, under the guidance of its club patron, was given the mandate of:
1. Carrying out health education.2. Cleaning the school and its environs3. Developing a school health library with adequate material
on health matters.4. Starting a tree nursery for the purposes of growing trees for
the conservation of the environment5. Starting a school garden that they can grow vegetables to
supplement the school diet.
All the schools now boost of a tree nursery. Survey primary, Merigwet primary, Mbombo primary, Minjore primary and Githima primary have used the trees for Income Generating Activity (IGA). The schools sell the seedlings from the tree nursery to the neighbouring community members. Survey primary have gone a step further and developed a school garden for planting Sukuma Wiki to supplement their school diet.
The school health clubs hold 2 health fora each week to educate fellow pupils on the significance of proper hygiene and sanitation. This has helped the pupils build the knowledge, skills and means to transform their personal hygiene and sanitation around the school and even in their respective homes.
Survey School Health Club members
18
19
Trees grown at Survey Primary School
A Leaky Tin placed near a toilet in one of the homesteads
20
Francis Musota’s Story
21
PROPER HYGIENE PRACTICES REPLICATED AT HOME
Francis Musota is a 13 year old pupil at Survey Primary School. He is the secretary of the school health club and the only boy in a family of 4 children. Before the AMREF school health project was introduced in his school, Francis was not keen on proper health and sanitation. Due to illness mostly stomach upsets and diarrhoea, he frequently missed school.
“The AMREF project was a major boost to me as a pupil.” says Francis.
“The school health club patron at my school came with information about proper hygiene and sanitation and PHASE kits that contain beneficial information on water, hygiene and sanitation.”
Apart from this information, Francis is also thankful for the practical lessons taught by the school health club patron.
What Francis was able to master fast was how to construct leaky tins and how to use them. To quench his thirst of learning about proper hygiene and sanitation, he joined the school health club.
A week after joining the club, Francis went home and convinced his parents and siblings to construct a leaky tin and place it strategically near the toilet. He imparted the knowledge on the importance of leaky tins and how it would help prevent water related diseases and improve the hygiene and sanitation in their home.
Francis's parents were receptive to his message. They told him they could not afford a bucket to construct the leaky tin but they promised to get him a 5 litre plastic container. He was elated that his parents embraced the idea and he made it his responsibility to ensure that the leaky tin had water in it at all times.
Since then, Francis has not missed a single day of school due to water and hygiene related diseases.
During the weekends, Francis helps his father clear the bushes and grass around the compound. He believes that this particular exercise has brought him closer to his dad and he can freely discuss other issues that affect him as a teenager.
“When I grow up, I hope to be a doctor and help the people of my community fight disease, especially water related diseases like diarrhoea and typhoid.”
Training of Teachers and PTA MembersThe project trained 15 teachers and 15 PTA members from the 15 selected schools in the division. These teachers and PTA members are the community champions driving change through communicating the significance of proper health and sanitation.
The training was carried out by the DPIT comprised of Division Education Officer, Division Public Health Officer, the area Chief, AMREF Project officer, Nurse In charge, Olmoran Health centre and the Division Water officer. The DPIT was involved in identification of issues to be addressed and planning for implementation of the project.
The 15 teachers trained on PHASE trained their fellow teachers, school health club members and pupils in their respective schools. The teachers and pupils trained, shared the information on proper hygiene and sanitation practices with the members of the community and other out of school children.
The training of PTA members ensured that all community members adopted proper personal hygiene and sanitation behaviour. The training brought a sense of project ownership since the community members felt that the messages of proper hygiene and sanitation were being brought by one of their own thus readily embracing the information shared.
Emily Gichui, one of the PTA members who went through the training made it her personal mission to educate her community members on proper hygiene and sanitation.
22
23
Pupils enjoy washing their hand from one of the Leaky tins in the school
24
Emily Gichui’s Story
25
CHAMPIONING A HEALTHIER COMMUNITY
Emily Gichui is a 36 year old mother of six. Before the hygiene and sanitation training, she was of the assumption that she knows everything about hygiene and sanitation.
She is thankful that the training taught her about trachoma as she had no clue what trachoma was nor its causes or how to prevent it.
Emily says that many in her community are ignorant on issues of hygiene and sanitation but she is determined to inform her neighbours on the significance of proper health and sanitation.
Her mission is to teach her neighbours how to construct leaky tins and use them. She acknowledges that although the attitude towards proper hygiene and sanitation is changing, the change is slow. Despite this, she hopes that after imparting this knowledge, the community members will embrace the notion of proper hygiene and sanitation and that there will be a reduction of water and hygiene related diseases.
“My hope is to see a healthier community free from diseases like typhoid, diarrhoea and even trachoma,” says a passionate Emily.
Emily encouraged her children to join the school health club so that they could learn more about proper hygiene and sanitation and even practice it.
Emily is grateful for the AMREF School Health Project and she believes that even beyond the project, the PTA committee formed and trained by AMREF will continue to share information on proper health and sanitation. She acknowledges that it will be a challenge but she is encouraged by the comments she gets from fellow community members who have testified that the use of leaky tins and other good hygiene and sanitation measures has improved their health.
She hopes the trained PTA members will visit every corner of the community training and informing the community members of the importance of proper hygiene and sanitation.
LESSONS LEARNT
Involvement and Stakeholders Partnership Partnerships are a key element of AMREF's approach to project implementation. A key lesson learnt during the implementation was the significance of involving all stakeholders throughout the life of the project. With the involvement of relevant line ministries (Ministry of Education, Ministry of Public Health and Sanitation, Ministry of Water and Irrigation and the Provincial Administration), teachers, pupils, parents through the PTA and community members in the project implementation e.g through the digging the pit latrines and contributing towards the construction of the tank slabs, there was ownership of the project by the community. Through this the project hopes to achieve sustainability.
As every stakeholder was involved, their roles were clearly defined leading to smooth project implementation through mutual partnership which provided a deeper and broader appreciation of the project hence proper planning of activities.
Capacity BuildingCapacity building of the people involved in the project was a necessity for the success of project. Most of the teachers and parents in the division were not well versed with PHASE issues hence the need to carry out a capacity building exercise of 15 teachers and 15 parents from the targeted schools. The traning gave the teachers and the parents a sense of ownership since the hygiene and sanitation information was shared by one of them. The trained teachers and PTA members in turn trained other teachers, pupils and the community members on proper hygiene and sanitation.
Children as Effective Change AgentsChildren are effective change agents in communities as they are receptive to the communication approaches and materials presented to them to achieve sustainable hygiene and sanitation behaviour.
Ownership of Community ResourcesSustainability of water and sanitation facilities depends on the ability of the local communitity to carry out maintenance and curb vandalism of shared water resources. It is therefore importance to build the capacity of the
26
community on the importance of the water and sanitation facilities and also build the capacity of the schools to gather sufficient resources for the maintenance of these facilities.
To enhance the sustainability of the project, AMREF worked side by side with the people of Olmoran, building knowledge, skills and means to transform their hygiene and sanitation thus laying a foundation that will be felt for generations to come.
A Leaky Tin strategically placed near a pit latrine
27
28
Harry Njuguna’s Story
29
TRACHOMA PUT AT BAY
Harry Njuguna is a local maize farmer and a PTA member at Gathanji Primary School who went through the PHASE training. Harry says the training taught him about the causes of trachoma and how to prevent it.
He believes that it was only a matter of time before trachoma caught up with him and his family. Before the training, Harry would share sleeping space with his goats, but after the training he went back home and built a shed for his goats.
“I was amazed at how the houseflies decreased around the house,” says Harry.
From the training, he learnt that trachoma is spread by houseflies and from then, he made sure that his compound was clean and free from flies. He recognises that apart from the unreliable and inadequate rainfall, poverty was one of the reasons why the fight against poor hygiene and sanitation was proving to be a struggle.
“I know people have been informed about proper hygiene but if you do not have the money to buy a good or proper container to store your water, that information is worthless,” says Harry.
From the little money he got from his maize harvest, he bought a tank to harvesti rain water during the rainy season. For the past year, Harry has boiled his water and stores it in clean containers to avoid contamination.
Before the training, Harry had no leaky tin but now he is a proud owner of one and he has gone round his neighbourhood educating his neighbours on the importance of leaky tins and proper hygiene in the environment.
To his best of his knowledge, the School Health Project by AMREF was a success because it involved all the relevant people in the community in its implementation stage.
“The project involved everyone, from the Chief to the school going children to the older generation like me,” says Harry.
PICTORIAL
30
For more information contact
AMREF KenyaP. O. Box 30125-00100,
Nairobi, KenyaTel: +254 20 699 4000Fax: +254 20 609 [email protected]
www.amref.org