Supporting communities to develop sustainable solutions to improve the welfare of girls and boys in Kenya
In Kenya, our OVC team is working to strengthen systems at national and local levels to support the institutionalization of quality improvement in the OVC program to improve the welfare of girls and boys. This includes providing TA to our service delivery partners -including APHIA plus, AMPATH plus, and the Ministry of Labour Social Security and Services - to apply improvement techniques to strengthen care for vulnerable girls, vulnerable boys, and their households.
Kenya is a diverse country, and we don’t have one approach that works to improve OVC services; rather, our culturally sensitive approach involves identifying and responding to the unique needs and issues facing each community. One community in which we supported implementing partners to identify and respond to the specific needs of adolescent girls was in Longewani in Samburu County where we supported the work of our implementing partner APHIA plus Imarisha to lead a quality improvement community team to conduct a child status index (CSI) analysis and self-assessment based on the minimum standards to identify the major issues facing boys and girls. The assessment was a very participatory process, which involved community health volunteers interviewing children, teachers, community members and community leaders, parents and guardians, reviewing the children’s status record, and taking girls’ and boys’ age, sex, and health status into account. The CBO also looked at their service delivery model, applied the self-assessment tool and identified services they were not implementing well.
Our role through ASSIST was to train quality improvement coaches, to build their capacity to train the quality improvement team. We provided follow up visits, mentorship, tools and other materials, and ensured strong linkages with the Department of Children’s Services. We also provided overall guidance on the issues we thought needed to be addressed and the community and how. The quality improvement team was formed and trained in October 2013 with 15 members representing the government, community health workers, teachers, OVC caregivers and religious leaders. The best way I can describe the Longewani team is that they were very vibrant and had much energy, enthusiasm and determination. The team identified education and child protection as the major issues within the community, both of which were identified as affecting health outcomes.
Related to protection, the team identified early marriage as an issue that was leading to both poor education outcomes and poor health outcomes in the community. It’s due, in part, to the cultural belief that once a girl reaches puberty she is a woman and it’s acceptable for her to be married off. We also found that FGM/C in this community was linked with early marriage. Once girls underwent FGM/C, they were seen as being ready to be married. Another issue identified was high rates of children lacking birth registration, either because parents died and children were orphaned, or their birth was never registered.
Specific to education, the team identified very high dropout rates for girls in school. When the improvement team conducted more in-depth analysis to determine the causes for the poorer education outcomes among girl children, they identified that, while child marriage was partly the cause, two other factors contributed to low retention rates among girls in school. Girls were not going to school due to not having sanitary napkins, and also high fees for secondary school were also a barrier to attendance. Another challenge was that female genital mutilation is rampant in the community and most girls dropped out of school immediately after undergoing the right to get married. For this same reason, vocational training was out of reach. In interviews, girls said that, because they didn’t have sanitary napkins, boys would laugh at the girls at school and the girls would prefer to stay at home. They also mentioned that the community members expected them to get married and not continue with their education.
To respond to the child protection issues including child marriage and FGM/C, the quality improvement team worked with the provincial administration and school management committees to reintegrate girls who had undergone FGM/C back into school and worked to get them scholarships. The quality improvement team also created a system to link girl students to female role models in the community. This was very successful. One of the challenges that the improvement team faced was that they feared that by responding to FGM/C, they would be cursed by community elders since that is an accepted practice.
To respond to the education issues affecting girls, our improvement teams initiated kids clubs in school that specifically worked with girls and boys to respond to their needs and provide a supportive atmosphere for them. The team also created a program in which school fees would be paid for the rescued girls, and there was a model adopted to ensure the community would be able to pay school fees on their own in the future.
As a result of our quality improvement team’s interventions, in a short period the improvement team achieved very positive results: 6 girls were rescued from early marriages after undergoing FGM/C. The team involved school management committees to allow back to school the rescued girls. One hundred children got birth certificates; lack of birth certificates makes children miss out on school admission and other vital government services. Eleven secondary school children scored C+ in national Kenya Secondary School Certificate (KCSE) which is the minimum entry grade to the University as a result of mentorship, payment of levies and encouragement by the improvement teams, and 121 OVC got scholarships to school through community efforts and linkages with scholarship programmes.
There were some challenges the improvement team faced in improving the welfare of vulnerable girls and vulnerable boys in this community which couldn’t be solved. The nomadic way of life among the people in the community leads to families moving from one place to another for grazing land and water. This leads to both girls and boys missing large amounts of school time, which is a problem that was too large for the QI team to respond to. The area is prone to cattle rustling and conflicts and displacement. With the inter clan conflicts in the region, there have been some challenges to implementing the improvement work in the community in recent months. Even with these setbacks, we are impressed with the work of the improvement team and have been able to translate the learning from using a gender-sensitive approach to identify and respond specifically to the needs of boys and girls to other communities and quality improvement teams.
I have worked on OVC quality improvement in Kenya for many years now, and I have come to realize that communities have solutions to their own problems and those solutions are long lasting and sustainable, and our goal is to guide and support the communities to critically analyze and the problems and to provide them with the tools to create solutions.