An all inclusive UHC model ,Kisumu county governor Hon, Peter Nyongo’ shares a light moment with participants.Photo by; David Wadulo
COMMUNIQUE ISSUED IN KISUMU COUNTY AT THE END OF THE:
3RD UNIVERSAL HEALTH COVERAGE CONFERENCE, MAY 17, 2019
We, the delegates from national and county governments, parliamentarians, private sector, civil society, faith-based health providers, youth advocates, media, health professionals and community representatives attending the third Universal Health Coverage Conference from May 15th – 17th, and comprising more than 800 participants;
Convening under the Theme: “Revitalizing primary health care for sustainable Universal Health Coverage” by drawing lessons from the four counties implementing the National Government UHC pilot program (Nyeri, Machakos, Isiolo and Kisumu), and other county led UHC initiatives (Makueni, Laikipia and Kitui) and having shared experiences and strategies on how Kenya can attain Universal Health Coverage (UHC); resolve as follows under the banner – KISUMU UHC DECLARATION;
1. That there be a clear Universal Coverage Policy to guide National and County Government roles in the implementation of service delivery
ACTION: National and County Governments
2. That focus be given to strengthen household, village councils and community healthcare systems as part of accelerating primary health care delivery.
ACTION: County Governments
3. That referral systems be strengthened to link households to community health units and health facilities for appropriate utilization of services through adoption of Kisumu county’s “hub and spoke model”.
ACTION: National and County Governments
4. That a UHC financing model be developed taking into account a mixed pooling of existing insurance schemes, active purchasing of services through tax finance approach and opportunities for innovative community financing schemes.
ACTION: National and County Governments
5. That procurement and supply of health products and technologies be subjected to free market enterprise and adequately regulated for safety, efficient and timely deliveries.
ACTION: National and County Governments
6. That adequate investment be made for the training, deployment, management, leadership and governance of healthcare workers at all levels.
ACTION: National and County Governments
7. That the services of Community Health Workers be institutionalized, and their training based on a defined curriculum to empower them to adequately be part of primary health care at the village level with proper remuneration.
ACTION: County Governments
8. That the ongoing NHIF reforms be accelerated and comprehensively concluded to make it responsive to achieving the UHC agenda and the devolved health services.
ACTION: National and County Governments
9. That appropriate technology be identified and integrated as part of the benefits package in delivering Universal Health Coverage.
ACTION: National and County Governments
10. Enact appropriate legislation to facilitate flow of funds to health facilities for efficient service delivery.
ACTION: National and County Governments
11. That Public Private Partnership arrangements be initiated to provide opportunities for better coordination of Universal Health Coverage.
ACTION: National, County Governments and Private Sector.
12. That collaborative framework between government and faith based organizations, civil society organizations and citizen initiatives be strengthened for efficient and accountable utilization of resources for Universal Health Coverage.
ACTION: National, County Governments, Faith based organizations and civil Society Organizations.
Kenyan fisherman pull up their nets in the early morning as they fish on Lake Victoria . Photo by CARL DE SOUZA/AFP/Getty Images).
By Lorraine Anyango and Lavender Akinyi.
Drunk fish float on water surfaces and makes it easy for one to pick and have a meal.
As absurd as it sounds, this was one of the ancient fishing methods practiced by the luo community residing along Dunga beach on the shores of Lake Victoria in Kisumu.
The local’s sprinkled malt, traditionally known as ‘thowe’ used to brew traditional beer onto the water surface.
The sprinkled malt is digested by fish effectively making them drunk, causing them to pass out on the surface of the water.
Papyrus woven traps of all shapes and sizes were also used for trapping and catching fish,the most common trap was (ounga) which was an elongated papyrus basket in the shape of of fisherman’s hat,the trap would be partially immersed in shallow water to allow fish to swim in the trunk.
A method known as ‘Keke’ was also used. This involved placing huge tree logs across water points that showed signs of water movement, while providing spaces like modern fishing nets.
The traps would be placed after opening the space .The logs distributed water flow and fish were caught from gushing water through the spaces. The fishermen would just pick the trapped fish from the spaces.
There was also the ‘soyo’ method of harvesting fish , a spear- like stick is pushed into the fish holding it till its removed out of water .Soyo was often practiced whenever fish got stuck in water pools formed after flood levels from rainfall reduced or after high tides and lake water current that carried fish.
Use of strong smelling bathing soap while going for fishing was considered a taboo because it was believed that fish could detect scent and escape being caught by otete or any type of fishing net.
In the recent past Fish trade at Dunga has been a reliable food source that is economically sustainable due to organized fishing on Lake Victoria.
However fishing largely depends on the invention of efficient methods of fishing and development of the outrigger canoe for travel and fishing.
Given the close proximity to the lake shore and scarcity of rainfall in the region around L .Victoria, communities around depended on fishing.
The Luo elders developed and enforced special precautions to compensate for any dependence on fishing that could lead to over fishing. Only a certain group of people could do fishing, the activity was not open to all.
In effort to preserve fish population on Lake Victoria and rivers in luo land, the luo elders enforced what was known as closed season, the season was described as a period where resolved that there will be no fishing on L .Victoria.
The precautions revolved around seasons for fishing and the methods employed, this two regulated and control the population of fish.
The customary requirement also played a role in fishing regulations as only men were allowed to sail long distances into the lake to fish. Men did the fishing while women did the selling and preparing dried fish for shipment to other communities
The community elders knew that fish preservation was important for the overall survival of people hence they ensured a concept of fish preservation was carried out.
Despite of developing some of the best fishing equipment methods and technique. The fishing community still has challenges.
They have to cope with accidents involving snake bites which were common, sometimes other reptiles would be caught inside the otete.
There are other challenges affecting fishing at L .Victoria like the stinking stenches chasing away customers from the lakeside fish selling hotels.
The rotting hyacinth is adversely affecting the raw water entry point at dunga beach, communities neighboring dunga have lived with the bad smell and brownish commodity caused by the rot of the hyacinth which can cause water borne diseases.
Despite the challenges and problems the dunga people are resilient they are productive and enterprising.
Dunga’s environment attracts nature creation in a unique and peaceful way, for sports lovers there is introduction of ‘Kaya king’ an activity adding a catchy ingredient to the entertainment sector.
Some of the fish species one will get at Dunga includes Tilapia known to the local as Ngege, Nile perch (Mbuta), cat fish, kembong (Kamongo) dagaa (Omena) among others.
During colonial period the colonialist poked fun at how a large lake such as Victoria harbored nothing but small fish such as tilapia that is why they introduced Nile perch in the lake
Another attraction that comes along enjoying fresh fish at Dunga is watching the sunset .One catches a unique glimpse watching the sun at the interior far end of the lake casting its soft golden rays over the lake waters.
Dunga beach also serves as a perfect destination to watch the birds life and marine life around the the beaches of Lake Victoria it covers a vast acreage.
Kisumu’s government is focused on the conservation of this ecosystem such that one can view birds such as Sitatungas birds, pythons and in the evening hippos while enjoying the great sun downer in the evening at Dunga.
The boardwalk stands on top of the wetlands swamps that is made up of largely papyrus reeds built by team volunteers .There is also a small a museum at dunga that displays the waves and crafts made by different women groups around dunga village, many of the traditional luo artefacts including musical instruments, ornaments, costumes and many more you can also find eco magazines and old newspapers which gives a good view in traditional artifacts.
The venue can also be hired out for events and conferences. One of the latest visitor was Lupita Nyongo and the acclaimed British architect David Adjaye who designed the African American history Museum and plans to design a new art Centre in Kisumu.
Dunga beach reflects something ancient. The historic importance of Lake Victoria as a central feature in the lives of luo people living around L. Victoria it has three elements fishing, Agriculture and livestock
Dunga economy has continued to grow immensely with sunset hotel opened and joints such as hippo point and Impala sanctuary have drawn tourist eager to visit the sites.
There have been efforts by government of Kisumu to ensure Dunga is a tourist destination as well as reclaim the former Dunga wetlands and initiate some cool eco-tourism that gives value for their money
There are lots of new hotels and resort coming up in Dunga and the area is priving quite popular with Kisumu hip Urban youth and even foreign tourist , the missing link is good roads the County of Kisumu has put effort to combat the population in the area.
Cultural tuorism has played different roles in our country which are poverty alleviation, creating jobs for unskilled or semi skill workers in hotels.
There is still an urgent need to upgrade cultural tourism in Kenya and harness the huge potential this area holds to grow the economy build roads, railway networks and airport.
Cultural tourism practiced alongside dunga beach has helped change the lives of many communities around it and enabled them to overcome some of the challenges they have been facing .Creating self- employment with incoming developing activities has also been enhanced.
Adoption of bio gas at Dunga beach is expected to open up more opportunities for income generation large, biogas plant will create several activities ranging from technical management of biodigester to collecting organic wastes, fertilizers sale, cooking and electric charging services
Cooking on wood burning stove at dunga has led to daytime smoke reduction, under the project of dunga with AstaZeanea large community digesters. This will power kitchens and fish driers electric light for local fish processors, fishermen and market stalls avoiding collection of firewood will see a reduction in the cuts and bruses, accidents and assault which women experience on long treks away from the village and limit respiratory diseases
Kisumu County has potential of growth as a cultural destination from which the local people can start enterprises since it’s surrounded by vast lake resources such as beach tourism examples being Dunga and Lwangni beach.
Nothing is as sweet as the taste of fresh fish, right from the lake to the frying pan.
This unique experience is what welcomes you to Dunga beach, a long time fishing village on the eastern shore of Winam on Lake Victoria just south of Kisumu city.
“I can’t believe I have already consumed 15 pieces of ‘Fulu’ (tilapia fish that is yet to mature) ….. I just can’t get enough of this…mm it’s yummy.” Mary Wairimu says as she visited Dunga beach for the first time.
She is just one among the many local and international tourist that confirm that though dunga beach may not be a popular site yet, however those vast with it know it as one of those place where one can choose freshly caught fish and in few minutes time enjoy fish meal by the water.
The Kit Mikayi rock attracts both local and international tourist. Picture by Jacob Owiti.
By Lorraine Anyango and Lavender Akinyi
Kit Mikayi’s topography is fascinating, it’s one of its kind, its un-resist ably attractive to any one visiting the area or travelers playing the Kisumu- Bondo road for the first time.
Kit Mikayi is a large rock with three rocks on top. Kit Mikayi means ‘first wife’s rocks’ in Dholuo local language. This large Rock formation, lies in Kisumu’s Seme sub-county and its historic site in its own making .It relates to the greater luo traditions dating many years back.
Kit Mikayi is both a community and a cultural site, a sanctuary yet a tourist attraction site, its uniqueness enhances co-existence among the diverse users and addresses potential factors that influence community participation in cultural tourism for poverty reduction hence sustainable community development.
One of the ancient members of the Kit Mikayi Community, Mama Grace Akoth Waga, married in 1968 to a descendant of Ngeso ,the legend behind the rock, who was bestowed by the clan part of the luo immigrants from River Nile continuously shared old narratives on the rock formation and the traditional beliefs’ around it.
The belief’s and traditions associated with this large Rock are varied .Some believe that Mikayi (the first wife) went up the rocky hill weeping when her husband took a second wife.
Other narratives states that, an elderly man named Ngeso had a great love for the natural stone monument, Ngeso would go sit on the cave under the rock all day .He was so fascinated and consumed by this stone and his wife had no option but to bring his breakfast, lunch and dinner as he lay around the stone, or onto the stone itself .He ate most of his meals there.
There is also another narrative that states the rock formation reflects the Luo culture of polygamy. The rock formation consist of three stones lying on top of each other, Traditions have developed around this stones, Referred to the stones by the names of the huts of the first three wives.
Both in the olden times and presently, this rock structure held great significance for local people. People from different arrears have visited the rock hopping to receive blessings including wealth, rain and spiritual cleansing while others visit to meditate or do some soul searching. Hence different people perceive Kit Mikayi in different ways.
During dry spell elders could converge along the entrance of the rock for meditation and soul searching, where a wondrous snake called ‘Nyangundi’ was believed to decide if they could gain passage into the rock depending on the level of meditation and soul searching. The same evening the snake would move into the lake through some underground tunnel down the rock base and create huge clouds full of mist into the skies called Nyakoi which later transformed to rain.
The rock was also presumed to send visions to people as far as Alego, usonga in Siaya on the need to conduct sacrifices and avert calamities, this people would meet at Kit Mikayi on their night dreams.
People’s perception of Kit Mikayi is influenced by their gendered labor and roles, level of education, education, occupation and age groups. Various songs and dances are performed its content being beliefs emerging from Kit Mikayi’s existence .The most common songs hails praises to the leader from the community .The dances and songs performed here represent the wider cultural, spiritual, natural and economic significance of the site.
Women perceive Kit Mikayi in terms of its connection to nature more so than men , men on the other connect it to traditional beliefs ,The major cultural reason for people visiting the site is mainly for meditation purposes ,other reasons include nature visits and research and education ,People do not generally go their simply for relaxation.
Many recognize Kit Mikayi as a place used to perform animal sacrificial rituals, mainly during morning hours. The rituals were performed because of calamity such as drought or divorce or separation cases amongst the community, the sight has therefore been used to appease the higher power to help the community survive and prosper.
Religious people crowd the rock where it releases water, it is traditionally believed that monument possess therapeutic powers and this water can heal them. It has become a popular local pilgrimage site for the Legio Maria sect who visit the rock to pray and fast sometimes for several weeks. The sacredness of Kit Mikayi site has produced some unforeseen benefits to the community .Which have further led to strengthening of group its cohesion and its connection to nature, such benefits include ecotheirism.
Tourist visit the site to view and climb the rocks, listen to traditional Luo songs, and other dancers visit the homesteads as they support tourism.
Kit Mikayi sacredness keeps the people uplifted and driven to continually preserve the site .The luo people thus properly care for it and devote their time to share the story and significance of the site to others being it’s a natural site that reflect a vibrant heritage.
the stone also reflects a nuclear family which is evident in the in the luo community, where by the father, who is Ngeso, the second at the middle being the wife and the other stones lying beside the middle stone, symbolizes the children .Importance of conserving and preserving the site is not only for its cultural, Herbal, natural and spiritual reasons, but also for economic reasons as well. Kit mikayi has given life a religious or spiritual meaning to innumerable groups of people, Mikayi sacredness keeps the people uplifted and driven to continually preserve the site.
The National Museum of Kenya has worked to physically preserve Kit Mikayi and any other information relating to it inform of documents ,oral traditions and more as National monuments of Kenya.
Cultural tourism along Kit Mikayi has helped improve lives of many luos and has enabled them to overcome some of the challenges they have been facing creating self-employment along with incoming generating activities and improvement of programs has enhanced local participation. This has also led to the need for training and education of people within local communities so as to produce group of trained people to steer tourism. It has also promoted community pride by allowing people to work together to enhance economic and cultural developments.
Cultural tourism has also tried to maximize the potential of tourism for eradicating poverty by developing appropriate strategies in co-operation with all major stake holders, and the local communities to access a fair distribution of benefits of Kit Mikayi.
Kisumu County has potential growth as a cultural tourism destination from which local people local people can start enterprise .Since it is endowed with vast lake resources such as beach tourism, bird watching, rich cultural heritage, performing arts, unique formation of Kit mikayi rock.
County has enhanced community development through cultural tourism by involvement of community to ensure that their potential role is tapped and maintained through active participation in tourism industry.
There are several analysis that have been conducted on community around Kit mikayi ,The extent to which socio economic characteristics of the local people influence their participation in the cultural tourism, analysis on education level ,as well as tourism policy frame work.
Kisumu County has also ensured that research is done, Focused group discussion was also employed to establish the cultural significance of Kit Mikayi tourist site. The researchers collaborated with the village elders to identify and select residents participants were drawn from Kit Mikayi site.
The county is also planning to construct a bore hole to boost domestic work and farming activities and farming for residents living near Kit Mikayi. It has also opened more business opportunities where by women from different ethnic groups gather and sell their products like jewelries, African attires, beads, African cooking pots etc.
Conversational and others have started using the economic benefits of the sites to encourage people to remember their traditional beliefs and Oral history of kit mikayi and traditional beliefs and oral history of Kit Mikayi and promote conservation efforts around the site. This long lasting traditions are helping to conserve and preserve the site for the betterment of members of the community.
There are several factors that have affected growth of Kit Mikayi as a natural site: ethnic mistrust, inadequacy in competence among the internal sector management
Inadequacy in competence among the internal sector management, the community neighbouring Kit Mikayi lack seriousness in regard to the stones, outsiders like tourist who normally frequent the site tend to benefit much example the research they conduct and write articles of the site.
#Tembea Kisumu.
A pharmacists at Oren health center in Nyando sub-county confirms syrup content prior to dispensing.Picture by Jacob Owiti.
by Lorraine Anyango.
Medicines used to treat chronic disease have been taking a large proportion of total volume in the health facilities in Kisumu County in the last four months.
It’s further expected that chronic disease medicine volumes will increase dramatically if continued access is provided under the Universal health care program.
This is according to a recent medicines situation report submitted by the County Pharmacist dated March 18th 2019.
The chronic disease medicines are regularly provided and used for the lifetimes of individuals who need them.
Additional problems of affordability that faced people living with chronic diseases due to the lifelong nature of treatment and the frequent need for combination therapy have been reduced and nearly eliminated since the launch of the UHC pilot program in the county.
Pre- UHC pilot program, was characterized with low availability of medicines in the public sector, and patients were often forced to purchase some of the essential medicines in the private sector. This has however changed. High medicine prices were largely responsible for increase the cost of treatment.
During the same period, Kisumu County decided to decentralize their procurement process in an effort to meet local needs through increased local involvement, accountability and flexibility.
Kisumu County has shifted from push to pull distribution systems thereby creating the need for health facility data for distribution planning and ordering.
Under UHC, Kisumu country was allocated 510 Million shillings for health products and technologies and basic equipment.
Even with this allocation, Kisumu County department of health has faced challenges when attempting to address the medicines supply gap.
The challenges arises due to the county level budget for procurement of health products for primary health care not being maintained, so as to complement support from the national government.
Kisumu county government owes KEMSA a total of Ksh 77,526,555.98 in unpaid invoices for essential medicines and medical supplies delivered to Kisumu county health facilities, even though KEMSA has made efforts it may not always manage 100% fill rate.
Essential medicines and medical supplies that were supplied at the inception of UHC pilot have been used by most facilities well within the period ending 14th March 2019 with some stocks still in place although a few of the facilities have reported stock outs of some of the commodities.
KEMSA, however, failed to supply some essential medicines up to date, and these have been stocked out in nearly all the facilities. The most significant ones include ceftriaxone 1g injection, albendazole 400mg tablets, nifedipine 20mg SR tablets, chlorhexidine digluconate 7.1% for cord care, benzyl penicillin 5mu inj, phenobarbitone inj. and ampiclox 500mg capsules.
“There’s need to budget for county level procurement of stocked out medicines since such a situation is bound to occur again.” Dr Lawrence Otieno the County pharmacist notes.
Pharmacy workforce shortages constitute a major capacity limitation to the provision of pharmaceutical services and access to medicines in Kisumu County. The county currently has 46 pharmacists and 35 pharmaceutical technologists against a minimum requirement of at least 70 pharmacists and 190 pharmaceutical technologists.
“Recruitment of additional pharmacy workforce should be considered when developing medicines policies and pharmaceutical services and integrated into broader human resources for health strategic plans.” Dr Otieno adds.
The relative contributor to the county burden of disease of HIV/AIDS, TB and malaria, is relatively is huge in Kisumu county. The implications for the delivery and use of pharmaceuticals are profound.
However medicines for HIV/AIDs, TB and malaria drugs are supplied by the national government through KEMSA free of charge to the county. Whereas antiretrovirals and TB medicines are supplied on monthly basis, antimalarials and family planning commodities are supplied on quarterly basis.
In February 2019, the Health Information Systems department at the Ministry of Health introduced data sets for reporting of tracer essential medicines and non-pharmaceuticals onto the DHIS2. Kisumu county department of health is keen to embrace the usage of this reporting platform as it will give a clear visibility of the medicines availability across the county health facilities. Consumption reports from the month of March going forward will be submitted through DHIS2 rather than excel based emails.
Analysis of consumption is complicated by the diversity of commodity management systems used by health facilities. The need for more comprehensive information system is particularly acute in low level health facilities especially those that do not have trained pharmaceutical personnel.
As the county shifts from the Excel based reporting to the DHIS2 platform for reporting of tracer commodities, there’s need to support the sub county pharmacists to adequately tackle the challenges involved with reporting.