Devolved health services bringing new hope to far-flung communities

September 3, 2019

Paulina Muthoni with her baby, Stephen, attending a well-baby clinic at the Lodwar County Referral Hospital in Turkana County // Photo: Ngele Ali/UNDP Kenya

Having supported intelligent life for more than 3 million years, Turkana’s reputation as the ‘Cradle of Mankind’ makes it a truly unique place, with its rich history a source of both local and national pride.[1]The living conditions today, however, are challenging: increasingly prone to drought due to the effects of global warming, the climate in the County is amongst the harshest in Kenya, and the poverty rate is amongst the highest.[2]

Outside of the County’s capital Lodwar town, Turkana is comprised of sparsely-populated arid plains sitting between the mountainous border areas of the West and the expansive Lake Turkana to the East. For the County Government, providing public services effectively to all the largely rural, pastoralist population of over 1m people — spread out over c.65,000km of semi-desert — presents a real challenge.[3]

Setting up health care facilities in rural areas where most of the inhabitants are pastoralists is most challenging as communities tend to move often in search of pastures for their animals // Photo: Nicholas Wilson/UNDP Kenya

Some 52km from Lodwar at Lorugum Sub-County Hospital, Pauline Longor, 22, has become a mother for the fourth time. Her 12-hour-old baby boy sleeps next to her in the neonatal unit, accompanied by a handful of relatives. Two of Ms. Longor’s other children were homebirths: she explains that she didn’t have faith in this health centre before its conversion into a sub-county hospital, but is positive about her experience today. New mothers like Ms. Longor now receive a baby pack which includes a basin, baby towel and soap, acting as an incentive to safe birthing.

Pauline Longor, rests in the maternity ward after giving birth, awaiting clearance from the doctors to take her new-born baby home // Photo: Nicholas Wilson/UNDP Kenya

"When I gave birth to my two first children at home, I was under duress because there was no one to help me. But with the changes, I feel safe, there people to look after me, there are medicines in case of an emergency." — Pauline Longor

Providing postnatal care to Pauline is Jeremia Akolom, a Counsellor at the hospital. As a member of the local community, Mr. Akolom is a key bridge between the people of Lorugum and the County’s healthcare system. In an area with inadequate access to public health services, health workers like Mr. Akolom educate people on their human rights, as part of efforts towards bringing these services closer to communities. He notes that Ms. Longor’s case is an example of how health care services brought closer to the people post-devolution is transforming perceptions and social norms.

"Before there was only one health facility, but they were charging some money. A lot of our people can’t afford to give money — they might give a goat or something but you can’t do that every time. Now there is also this facility: we still charge… but if you can’t pay you can still be treated." — Jeremia Akolom

Jeremia Akolom is one of the health workers at the Lorugum Sub-County Hospital, where he supports community members to access health care services // Photo: Nicholas Wilson/UNDP Kenya

In March of 2018, UNDP supported training for Members of the County Assembly (MCAs) and technical staff on both human rights-based approaches to policymaking and public participation processes. This emphasised endogenization of the Sustainable Development Goals (SDGs) and careful consideration of the impact on special interest groups such as women, youth and those with disabilities in the budgeting process. Following this training, a Women’s Caucus was established in the County Assembly and a number of bills with a human rights focus were brought forwards.

One such bill later assented into law is the Community Health Services Act: this established Community Health Units at the Ward level (including in Lorugum), brought in Community Health Committees with mandatory representation of special interest groups and formalised the work of Community Health Volunteers (CHVs), introducing a monthly stipend for their work. Wilson Ikamar, Director of the Office of the Speaker of the County Assembly, says the training supported by UNDP directly contributed a new recognition of the value of engaging local communities on healthcare service delivery, including promoting the work of local health workers and CHVs.

Wilson Ikamar, Director of the Office of the Speaker of the County Assembly. Members of the County Assembly play a critical role in approving bills that are people-centred // Photo: Nicholas Wilson/UNDP Kenya

"[Community health workers] are recognized because they’re doing the sensitive part — they’re identifying serious illness, serving rural communities and helping mothers at the community levels… there is dignity there now that there wasn’t before, and they can gain respect at an official level. I think this Act was a product of the human rights-based approach we were trained on to recognize these sort of interventions." — Wilson Ikamar

Other bills which MCAs cite as having been influenced by the training on human rights-based approaches and public participation include the Water Act, the introduction of a bill combating gender-based violence (GBV) and the establishment of the Office of the County Attorney. Meaningful change from the top comes by empowering those on the ground and through prioritising human rights and public participation, the legislators of Turkana County are working to make this happen.






UNDP has supported human rights-based approaches in Turkana County through the Integrated Support Programme to the Devolution Process (ISPDP) in Kenya, which aims to enhance the effectiveness and efficiency of the devolution process and to give grassroots stakeholders a voice in the delivery of services by the devolved governments. ISPDP is a joint project run by UNDP Kenya and UN Women in partnership with the Government of Kenya, with the Ministry for Devolution and ASAL being the implementing partner and other national government institutions (CoG, CRA, KSG, IBEC) as responsible parties. The project is principally funded by the governments of the United Kingdom through DFID, the United States through USAID, Sweden through SIDA and the Royal Government of the Kingdom of Norway through the Norwegian Embassy in Kenya.

Disclaimer: This story is based on first person reports and interviews conducted during a visit to Turkana County in July 2019. The opinions expressed in this story are solely those of the interviewed individuals and do not necessarily represent the views of affiliated donors or organisations.