Towards the tail end of the year 2020, Kenya was facing an unprecedented crisis as a result of the Covid-19 global pandemic. Infection rates were on a rapid upward trajectory, deaths resulting from Covid-19 related health complications were also rising, not to mention the increasing strain on healthcare facilities that were ill prepared for a crisis of this magnitude. The lack of basic necessities for frontline workers such as personal protective equipment and even delayed pay, resulted in a nationwide strike by primary health care workers, putting further strain on the country’s health sector.
In addition to this, the country’s economy was on a downward spiral as many businesses were shutting down leaving thousands of breadwinners with no source of income to take care of their families, schools had been shut down indefinitely leaving thousands of children idle and unsupervised at home, exposing them to potential abuse. This increasing socioeconomic pressures resulted in the country registering a sharp increase in cases of alcohol and substance use as well as domestic violence within households countrywide.
The measures that had been put in place by the Kenyan Government to contain the spread of the virus such as restriction on movement, night-time curfews, social distance requirements, and public awareness campaigns, among other measures, did not seem to be effective as the number of new infections in the country continued to rise, to a point that transmission was no longer limited to those with a history of travel and their contacts but was also occurring within the local communities countrywide. This meant that the impact of the pandemic was further compounded especially for nomadic and rural communities because they had fewer coping mechanisms owing to their limited resources as a result of limited livelihood opportunities at their disposal.
It is in the backdrop of these increasing socioeconomic pressures faced by nomadic and rural communities, that Basic Needs Kenya in partnership with CBM Kenya launched an emergency response program in Kajiado and Bungoma Counties to offer social support to these communities with the intention of mitigating the negative impact of the Covid-19 pandemic. The emergency intervention targeted vulnerable households particularly with persons living with some form of disability either psychosocial or physical.
Why Kajiado and Bungoma?
In Kajiado County, Basic Needs Kenya had previously been involved in mental health programs targeting nomadic communities in the county and had supported the establishment of six community mental health clinics where service users could access mental health services. As a result of the pandemic however, the Kajiado County Health Services had reported an increased need for mental health and psychosocial support response in communities within the county, as well as for front line workers. Across all the six community mental health clinics, it had been reported that service users with intellectual and psychosocial disabilities as well those with neurological conditions such as epilepsy and cerebral palsy faced increased vulnerability and therefore needed urgent social support to enable them cope better with the economic and social stresses that had been brought about by the pandemic.
In Bungoma County, Basic Needs Kenya was involved in a livelihoods program with small holder coffee farmers working in partnership with coffee societies across three sub-counties. As a result of the stress brought about by the pandemic, there were increasing reports within these communities, of cases of mental health problems linked to loss of income, unemployment, domestic and gender-based violence and stigma around Covid-19 as well as around mental health problems. Just like in Kajiado County, communities in Bungoma needed urgent social support to enable them cope better with the economic and social stresses that had been brought about by the pandemic.
Below are some of the stories as told by the community members from the intervention areas.
The Covid-19 pandemic negatively impacted livelihood opportunities for persons living with disabilities in my community
Meet 30-year-old Ezekiel Sananka who has worked as a Community Health Assistant for two and a half years and is currently attached to Mile 46 Health Centre in Kajiado West Sub County. CHAs are government employees in the Ministry of Health responsible for public health promotion and supervision of Community Health Volunteers. Ezekiel’s primary role is to act as a link between the community and the health facility, and he played a key role in the successful implementation of the Covid-19 emergency response program in Mile 46.
One of my primary tasks at the onset of the emergency program was identifying service users from within communities in Mile 46, who were most vulnerable and were in urgent need of support. Therefore, during the implementation of the Covid-19 emergency response project, working together with Community Health Volunteers, we identified 30 beneficiaries from various households in this community that rely on the Mile 46 health centre for their medical needs. These beneficiaries primarily included persons with mental disorders, epilepsy as well as physical disabilities.
From our household mapping exercise, we had about 70 potential candidates for the program owing to the high number of persons living with various forms of disability within this community, but unfortunately, we were only able to select 30 who we determined were the most vulnerable, and this was done through administering a household vulnerability assessment tool that Basic Needs Kenya provided us with.
The 30 beneficiaries we selected from this community had the option of receiving monthly food parcels for three months or receiving cash amounting to Ksh2,500 per month for three months, and this was based on what they felt was their most urgent need. It was interesting that we had a 50-50 split, with 15 of the beneficiaries preferring cash while 15 preferred to receive food.
From the feedback we got directly from the beneficiaries, those receiving monthly food parcels got a significant relief because their disabilities had limited their ability to take part in available income generating activities. For instance, the communities in this area primarily rely on sand harvesting and livestock keeping as their source of income, and these are physically intensive activities that persons living with disabilities whether physical or psychosocial will have a hard time taking part in. They therefore have to rely on their families and other members of the community for food and other basic necessities. The situation was further compounded by the Covid-19 pandemic which negatively impacted these livelihood opportunities for instance, reduced demand for sand because many construction projects had been temporarily halted and reduced demand for meat because many hotels had been shut down. Therefore, the food parcels that they have been able to receive during the emergency period went a long way in ensuring that they had adequate food on the table.
On the other hand, the beneficiaries who received cash were very appreciative because they were able to direct the cash to their most pressing needs, with the biggest being the purchase of medication. It is worth noting that psychotropic and anti-epileptic medication which are commonly prescribed to service users in this community are often very expensive and it is therefore a struggle to afford them. It was interesting to note that many of these beneficiaries felt like drugs were more important than food.
As a community, we understand that this intervention was short because it was an emergency response project however, we would like to request the project funders to consider a more long-term program to ensure we can have a greater impact on the community here. Some of the ways we can ensure that such a program is sustainable is through setting up and empowering groups of persons living with disabilities to engage in livelihood activities suitable for them, and also ensuring that they are all registered with social protection services provided for by the government so that they can receive the benefits they are entitled to.
There is still a lot of stigma in this community when it comes to persons living with disabilities, with it being associated with sin, and this has resulted in many families hiding members with disabilities. It will therefore be important for us to educate the community so that we can collectively tackle the stigma.
For my family, it is often a choice between buying food or buying my medication and mostly, they choose food
Meet 20-year-old Naisia Koikai, a single mother to a one-and-a-half-year-old child, Evaline Seletoi. Naisia has had Epilepsy since she was five years old and is one of the 30 beneficiaries from Mile 46 in Kajiado West Sub County who received social support courtesy of the Covid-19 emergency response program. Naisia comes from a large polygamous family where her mother is one of seven wives in the household, with each wife having at least eight children. Currently there are four members in the household, Naisia included, with some form of physical, psychosocial, or neurological disability.
I was forced to drop out of school when I was 19 years old and this was soon after I had given birth to my daughter. I started experiencing more frequent epileptic attacks while in school coupled with ridicule from schoolmates, and this made it impossible for me to continue pursuing my education.
My family learnt about this emergency program from a Community Health Volunteer who selected me as one of the beneficiaries to receive monthly food parcels. Receiving the food was so beneficial for me because mostly for my family, it has always been a choice between buying food for the family or spending the little money they make from livestock keeping, on my medication and mostly, they choose food. However, because we have been receiving food for the past three months courtesy of this intervention, my family has been able to buy my medication with the money they would have otherwise spent on food.
We have also learnt a lot about the Corona virus and measures we can take to protect ourselves, and we make it a point to share the same information with our neighbours. It especially serves as a good reminder for community members when we see our mothers walking around with lesos branded with Covid-19 awareness messages in addition to hearing regular awareness messages over the local radio.
More families within this community are coming out openly to seek for help for their family members with different forms of disability
Meet 30-year-old Ntoyian Damaris, a wife, mother of two, and currently working as a Community Health Assistant attached to Oletepesi Health Centre in Kajiado West Sub County. CHAs are government employees in the Ministry of Health responsible for public health promotion and supervision of Community Health Volunteers. Damaris’s primary role is to act as a link between the community and the health facility, and she played a key role in the successful implementation of the Covid-19 emergency response program in Oletepesi.
In the three and a half years that I have worked as a Community Health Assistant, this has been the first time in this area where an organization has come in to help persons living with disabilities. The cash transfer program has really been helpful especially taking into consideration that medication such as Phenobarbital and Carbamazepine that are often used by Service Users in this community are quite expensive. The cash therefore has enabled them to be able to access medication for at least three months. Unfortunately, whereas we are grateful, this is just a temporary reprieve because once this emergency program is over, access to medication will again become a challenge.
I would like to point out however that one of the interesting results from this emergency program is that more families within this community are coming out openly to seek for help for their family members with different forms of disability. During the household mapping exercise that we conducted at the start of this intervention, we were able to identify 30 individuals from within this community that were living with some form of disability either physical or mental, however today as we are approaching the close of the program, my list has grown to 70. I do not know what we can attribute to this increase, maybe it is the fact that they have seen others receive medication or maybe it is because they have seen that we genuinely care about them.
In this community, parents have a tendency of keeping their children hidden if they have any form of disability. For instance, you may go to a household and the parents tell you that they have three children, but the truth is that they have four children but the fourth one is not counted because they have some form of disability and the parents do not want anyone to find out. However, since we started this emergency program, I have noted that more and more parents within this community are now opening up and coming out to seek for help for their children.
Whereas I would like to help more and more people, my work is very challenging. As a Community Health Worker, I do not receive any form of travel allowance, so I mostly partner up with one of my Community Health Volunteers, we fuel a motorbike from our own pockets and use it to traverse this vast area. I mostly do this because I am passionate about serving and helping my community. I believe that community work is essentially voluntary and a calling from God. I feel fulfilled when I am able to ensure that a child or a sick person within my community is able to access much needed medication. Now it is especially more fulfilling because thanks to the financial support I and other Community Health Volunteers have received from Basic Needs and their partners CBM during implementation of this emergency program, we have been able to reach out and assist persons living with mental and physical disabilities within my community, something that never used to happen.
It would be a really good thing if this program could be extended because the distances that service users here have to travel to access the health facility at Oletepesi are quite far, especially considering the rough terrain and this poses a challenge in the access to medical services. For instance, because of the bad terrain, it costs about Ksh400 to travel for just 12 kilometers by motorbike. Just try to imagine the struggle a mother goes through trying to ferry her child suffering from epilepsy using a motorbike on this tough terrain. It would be great if we could have monthly outreach programs as this will reduce the need for tedious and expensive travel to and from the health center.