The end of an era

After more than 30 years of supporting health services in Turkana, Northern Kenya, MS Kenya is stepping down its support to mobile clinics firstly in Kaikor. However, MS will remain supporting the small CBO Akosi for a couple of years. Danish Development Worker Ole Holst, looks at some achievements gained and some implications for the future

The white Land Cruiser rolls up in front of Kaikor Dispensary and the driver leaps out. He first locks himself in the Dispensary, then after some time and together with the watchman, starts carrying two big wooden boxes full with drugs into the vehicle. Soon after, some folding chairs, tables, camp beds and mosquito nets go in the same way. Then, a cooling box with icepacks and vaccines is loaded into the spacious car.

People start to gather round. They want a lift!

Look a car!

The driver, a Turkana and also the mobile clinic nurse, looks at his passenger list and allows six people to settle down on the two benches in the back of the car. A few hopeful individuals pester him to give them a chance but they are firmly turned away. But added to the cargo is a gas cylinder and some carton boxes with drugs for Koyasa Dispensary. Two bags of maize, a bag of tobacco, a bag of sugar for the women groups are strapped to the roof rack and finally… they are ready to go. The nurse and his fellow health worker, the patient attendant, enter the front seats. Off they go!

Three hours later, after a rough ride along a dusty track, they arrive at a small settlement called Lokamarinyang. The village consists of approximately 50 huts and a police post with half a dozen iron sheet cabins. This is the last settlement before the Ethiopian border post at Kibish only 40 km further on.

Immediately the villagers discover the white car they throw what is in their hands and gather round it. It is not every day a car passes through here and they want to hear news.

Last-stop clinic

After some talk with the chief, the vehicle proceeds to a nearby seasonal river where they find a big tree in the shade of which they put up the chairs and tables. This now is the open-air dispensary and immunisation clinic.

This scene has been happening around 40 times a year for the last 12 years. But what makes this particular mobile clinic all the more memorable is that there will not be another one. At least, not one sponsored by MS Kenya.

It is nothing less than the end of an era.

As far back as 1973 Danish nurses crisscrossed Northern Turkana bringing health services closer to the people. Then, in 1992 MS Kenya signed a partnership agreement with the Ministry of Health to run what was called Kaikor Mobile Community Based Health Care (CBHC) Programme (covering an area of 8000-km2 around Kaikor). It is this programme, which finally ended in March 2004.

Leaves a mark

During the twelve-year period, health services have been provided to a population of 15.000 and hundreds of children have been immunised for measles, polio, whooping cough, tetanus etc. Hundreds of mothers have received antenatal care. Hundreds of people have received treatment for malaria, intestinal worms, skin and eye diseases etc. Community Health Workers, Traditional Birth Attendants, Local Health Providers have been trained to enhance the hygienic standard and help their fellow tribesmen if need be. Dish racks, pit latrines and water filters appeared in many homesteads.

In addition, the CBHC approach also built the capacity of people in the settlements on ways of forming income-generating groups. The CBHC trained them on small-scale business management, constitution writing, group dynamics, holding meetings, democratic decision-making etc. Small shops have cropped up in the villages selling sugar, maize, tobacco, oil, cooking pots, clothing, and pearls. Sometimes you can even find Coca Cola.

Change, ideas, opportunities

Realising that MS would not stay in Kaikor forever, a Community Based Organisation called “Akosi” (Turkana word for “ours”) was formed in 2000. MS has built the capacity of the small organisation to handle its own affairs according to its own visions and wishes. Akosi now seeks to position itself as the entry point of all development in its area of operation.

Akosi has established partnership with a number of other development agencies that work in the area. The Netherlands Development Organisation, SNV, will work to further capacity build Akosi at all levels. A livestock-marketing project with AMREF is emerging and Akosi is constantly lobbying the Arid Lands Resource Management Programme, the Ministry of Water, the Constituency Development Fund and other Government institutions to support its activities. To further ease the transitional period MS Kenya linked Akosi to Ufadhili Trust, an intermediary organization for insights on local resource mobilization, and with the International Workgroup for Indigenous Affairs for a Human Rights Programme.

One of the many concerns on Akosi’s agenda is applying for funding for a new CBHC programme. There are people in the Akosi area who still have to cover long walking distances to get to a health facility. Only this time, the mobile clinic is their idea.

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Service delivery no more

Times are changing. Many international NGOs are moving from service delivery and on to advocacy, capacity building, human rights etc. This change is not due to diminishing need for schools, health facilities and agricultural extension services. It is motivated by the realization that poverty reduction will not be accomplished until governments – in this case the Kenyan government – take up their due responsibility of providing services to all the people of Kenya. The realization that service delivery creates an unhealthy dependency.

The immediate consequences of the new donor approach may be hard to face for many community-based organisations that rely on donor funding for their activities. But the realization remains: that for as long as basic services are provided by international donors, local governments will evade taking up their rightful responsibilities…