A Case Study on Access to Health Services by Vulnerable and Marginalized Groups in Kenya (World Bank supported Initiative)

The Ministry of Public Health and Sanitation (MOPHS), through its World Bank supported projects: the Kenya Health Sector Support Project (KHSSP), the East African Public Health Laboratory Network (EAPHLN) and the Total War Against AIDS (TOWA) project under the National AIDS Control Council (NACC), undertook jointly to develop, separately implementable Vulnerable and Marginalized Peoples Plans (VMPPs) to increase the accessibility of health services to the Vulnerable and Marginalized Populations (VMPs). Specifically, the assessment was to establish

  • The extent to which the Indigenous Peoples (IPs) are benefiting from the three projects,
  • The barriers to accessing services provided under the three projects and;
  • To develop action plans which provide implementers with practical measures to guide implementation, monitoring and evaluation of IPs benefits from the project activities given the geographical, financial and socio-cultural factors.

The World Bank through OP 4.10 policy on indigenous populations here referred to as Vulnerable and marginalized groups; the term “Indigenous Peoples” is used in a generic sense to refer to a distinct, vulnerable, social and cultural group6 possessing the following characteristics in varying degrees:

(a)  self-identification as members of a distinct indigenous cultural group and recognition of this identity by others;

(b)  collective attachment to geographically distinct habitats or ancestral territories in the project area and to the natural resources in these habitats and territories7

(c)  customary cultural, economic, social, or political institutions that are separate from those of the dominant society and culture; and

(d)  an indigenous language, often different from the official language of the country or region.

(excerpted from the World Bank website: http://web.worldbank.org/WBSITE/EXTERNAL/PROJECTS/EXTPOLICIES/EXTOPMANUAL/0,,contentMDK:23384101~menuPK:51508119~pagePK:64141683~piPK:4688102~theSitePK:502184,00.html)

The assessment was carried out by a consultancy firm last year and the information for the East Africa Public Health Laboratory Networking project were was collected from thirteen communities in eight Counties/Districts. The 13 vulnerable communities were: Sengwer, Ngikebotook, IL Chamus, Endorois, Sabor, Ogiek, Konso, LKunono, IL Waana/Malakote, Waata, Boni/Aweer, Saanye and Munyoyaya.

Some of the findings from this assessment with focus on the East Africa Public Health Laboratory Networking Project included:

  1. All the vulnerable communities experience big challenges in transportation of specimens to the major hospitals because of distance to the laboratory
  2. There is limited mobilization and sensitization of the vulnerable communities on the laboratory project and it is importance. Most VMG communities are not aware of the project services.
  3. The outreach services that the project is supporting are only closer to the health facilities and vulnerable groups living further cannot access these outreach services which are important for emergency testing.
  4. Bio Harzardous waste are being generated from the laboratories and lack of sufficient incineration equipments adds to the problem of proper disposal of waste at the laboratories.
  5. The project has invested quite significantly in availing basic laboratory equipmenst and consumables and this is assisting the vulnerable groups in access quality diagnostic services.

Recommendations on how to increase accessibility and utilization of EAPHLN services

  1. There is a need for awareness creation about the existence of the EAPHLN project among the VMG communities. This can be done through the use of CHWs, CHEWs and the use of community health units as mechanisms for creating awareness and demand for laboratory services.
  2. The EAPHLN should establish mobile laboratory services to enhance access to testing services for the identified health problems facing the VMG communities. In this regard, awareness on outreach services should focus on all people in the VMG communities and not women and children alone as is the case presently.
  3. There is a need for a multi-pronged capacity building efforts to build the capacity of laboratory staff in IT skills and descriptive epidemiology while the Community Health Workers should be trained in disease surveillance, be empowered and facilitated to become EAPHLN local agents for improved referral system at the community level.
  4. There is a need to put in place mechanisms to address the gaps in interventions for laboratory services with regard to access, equity and utilization of Laboratory services by the VMG communities as well as ensure that there is proper disposal of waste generated by the laboratory services in all the places where either the satellite or major laboratories are situated for enhanced environmental health.

Generally the study was eye opener as the project is implementing an environmental and social management framework strategy in addressing some of the gaps identified in this assessment. The report has specific work plan targeting the vulnerable groups and how the specific Bank supported project will implement this.

A draft  report  of this  study can  be found on  this  site  at http://www.eaphln-ecsahc.org/kenya/?wpfb_dl=42

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