Discussion about entry: Nomadic Communities Trust: Bringing Healthcare to Nomadic Populations in Remote Locations

Hi Tyler,

You pose an excellent question and one we have often been asked. We recognize the importance of sustainability and this is why we have assisted our HIV Counselors to create and register People Living With HIV/AIDS (PLWHA) Support Groups in the communities they serve. These groups will be our model for sustainability.

The groups are not only critical in providing for emotional support for HIV positive people & the dissemination of information, but will also allow for PLWHAs to have their own entity and begin income-generating activities. Such activities – bee keeping, beadwork, livestock, etc – will be dependent upon each group, their capacities & environment, but they will allow the individual PLWHA groups to generate a steady income. NCT will assist these support groups financially by helping them find markets for their work & teach them how to apply for small government grants, but intends for them to be independent. This way, by having the counseling & testing counselor linked with the income-generating PLWHA group in each community, the counselor’s work will be embraced by the community (similar to a traditional birth attendant) and he/she will be compensated directly by the community for his/her services. Compensation may be monetary or in terms of goats, milk, etc, but it will allow the community to have continued access to HIV/AIDS education, counseling, & testing without requiring NCT’s further involvement. Because of the close link between reproductive health & HIV/AIDS, the support groups also work closely with (and make referrals to) our family planning counselors who would also be incorporated into the community similar to the HIV/AIDS testing counselors. The groups will continue to be visited by NCT for medical services but may be able to contribute more than their current “token” fees once their more financially stable.

Having explained our long-term vision, it is important to realize the time it takes to accomplish this vision – we need to establish a base within a community & gain trust given that the services we offer are often surrounded by stigma, suspicion, and/or tradition (HIV, family planning, FGM). It has taken 7 years for us to reach this model (and we are not quite there) in Laikipia and will probably take an additional 4 or 5 in Samburu. Once a community is self-sustaining, NCT can move to the next region, but we refuse to leave until we are certain. The reason it takes so long (and why NCT is dependent upon funding) is because we are reaching people who have absolutely nothing.

Though we work very closely with the Ministry of Health in Kenya (we source testing kits, condoms, birth control, and vaccinations through them & report all our work regularly), the government is not yet in a stable position to absorb our program. As for our own income-generating work, our interest is providing people without access the healthcare they deserve – we cannot charge our clients (past the token fee or the occasional gift of milk or a goat we receive) and we are a small organization that has no plan to generate an income.

So, in summary, our vision is to enter a region which has absolutely no access to healthcare, offer them services via our mobile clinic, access training and compensation for community members to become counselors in HIV/AIDS & family planning, gain the trust & client-base needed for our services to be recognized as vital to the community, assist the community and to create its own support group & income generating activities, link it directly to the MOH to access kits & support without NCT, continue to offer the community health services but at an increased fee (once the support groups are in a financial position to pay such a fee), and move to the next region in need. We will always be dependent upon donors because we will always be reaching the poorest of the poor & most marginalized populations that exist. However, as long as wealthier donors & countries agree that basic healthcare is a universal right, we provide a model through which a community with absolutely nothing can hope within several years to have a sustainable healthcare system.

I hope my answer was not too long-winded and if you have any other questions, do not hesitate to ask!

Cheers!
-molly