Nomadic Communities Trust: Bringing Healthcare to Nomadic Populations in Remote Locations
Even as medical technology and medications progress, there is an enormous gap between medical care in rural & urban environments and an even larger gap between rural agricultural communities and the nomadic pastoralist populations that exist in Northern Kenya. Because of the traditional practices, tribalism, and geographic inaccessibility, these communities have been left without any form of healthcare from the government, NGOs, or Faith-based organizations. Nomadic Community Trust is innovative in both its mobility and its personnel by adapting to the unique conditions of this region.
Mobility: After five years of operating a vehicle only mobile clinic, NCT recognized the necessity to integrate camels and bicycles in order to access communities that lacked roads and had difficult terrain. The camels are effective because they can carry large loads of medicines & camping supplies and are native to the region. Experience led NCT to utilize an already existing form of transportation to reach formerly un-served locations.
Personnel: Other NGOs employ outside personnel who are not familiar with the region or tribal customs. NCT focuses on using community members to provide services to their own community. Nurses speak the tribal dialects fluently and the camel-handlers are familiar with the region to ensure the safest routes. Patients are much more receptive to someone who is well aware of all their traditions because the health education is tailored to apply to that individual community. By using local personnel, the communities are more invested in the clinic, which is crucial to the sustainability of healthcare in this environment.
NCT transforms the traditional health care system because it organically seeks solutions to healthcare access in a way that can easily be replicated in any country. The combination of a mobile clinic and counselors who are based in the community optimize the amount of patients that can be reached and ensure continued coverage.
About You
Location
Project Street Address
Project City
Project Province/State
Project Postal/Zip Code
Project Country
Your idea
Focus of activity
Service/process
Year the initiative began (yyyy)
2000
Positioning of your initiative on the mosaic diagram
Which of these barriers is the primary focus of your work?
Patients not empowered
Which of the principles is the primary focus of your work?
Democratize access
If you believe some other barrier or principle should be included in the mosaic, please describe it and how it would affect the positioning of your initiative in the mosaic:
Reaching unserved populations with health care
Name Your Project
Nomadic Communities Trust: Bringing Healthcare to Nomadic Populations in Remote Locations
Describe Your Idea
Even as medical technology and medications progress, there is an enormous gap between medical care in rural & urban environments and an even larger gap between rural agricultural communities and the nomadic pastoralist populations that exist in Northern Kenya. Because of the traditional practices, tribalism, and geographic inaccessibility, these communities have been left without any form of healthcare from the government, NGOs, or Faith-based organizations. Nomadic Community Trust is innovative in both its mobility and its personnel by adapting to the unique conditions of this region.
Mobility: After five years of operating a vehicle only mobile clinic, NCT recognized the necessity to integrate camels and bicycles in order to access communities that lacked roads and had difficult terrain. The camels are effective because they can carry large loads of medicines & camping supplies and are native to the region. Experience led NCT to utilize an already existing form of transportation to reach formerly un-served locations.
Personnel: Other NGOs employ outside personnel who are not familiar with the region or tribal customs. NCT focuses on using community members to provide services to their own community. Nurses speak the tribal dialects fluently and the camel-handlers are familiar with the region to ensure the safest routes. Patients are much more receptive to someone who is well aware of all their traditions because the health education is tailored to apply to that individual community. By using local personnel, the communities are more invested in the clinic, which is crucial to the sustainability of healthcare in this environment.
NCT transforms the traditional health care system because it organically seeks solutions to healthcare access in a way that can easily be replicated in any country. The combination of a mobile clinic and counselors who are based in the community optimize the amount of patients that can be reached and ensure continued coverage.
Innovation
Define the innovation
Even as medical technology and medications progress, there is an enormous gap between medical care in rural & urban environments and an even larger gap between rural agricultural communities and the nomadic pastoralist populations that exist in Northern Kenya. Because of the traditional practices, tribalism, and geographic inaccessibility, these communities have been left without any form of healthcare from the government, NGOs, or Faith-based organizations. Nomadic Community Trust is innovative in both its mobility and its personnel by adapting to the unique conditions of this region.
Mobility: After five years of operating a vehicle only mobile clinic, NCT recognized the necessity to integrate camels and bicycles in order to access communities that lacked roads and had difficult terrain. The camels are effective because they can carry large loads of medicines & camping supplies and are native to the region. Experience led NCT to utilize an already existing form of transportation to reach formerly un-served locations.
Personnel: Other NGOs employ outside personnel who are not familiar with the region or tribal customs. NCT focuses on using community members to provide services to their own community. Nurses speak the tribal dialects fluently and the camel-handlers are familiar with the region to ensure the safest routes. Patients are much more receptive to someone who is well aware of all their traditions because the health education is tailored to apply to that individual community. By using local personnel, the communities are more invested in the clinic, which is crucial to the sustainability of healthcare in this environment.
NCT transforms the traditional health care system because it organically seeks solutions to healthcare access in a way that can easily be replicated in any country. The combination of a mobile clinic and counselors who are based in the community optimize the amount of patients that can be reached and ensure continued coverage.
Context for Disruption:
Nomadic Community Trust (NCT) operates an integrated mobile clinic system that utilizes trucks, camels and bicycles to reach remote locations in Northern Kenya. The communities served are primarily nomadic and therefore have not received adequate healthcare or health education, resulting in poor health outcomes, unsustainable population growth, and deepening poverty. These populations are extremely isolated, illiterate, and the majority have never been tested for HIV, are in desperate need of medical services as well as counseling in HIV/AIDS, reproductive health, and female genital mutilation.
Currently, most mobile health clinics only operate via four-wheel drive vehicles that are unable to access the truly remote populations that live in terrains that vehicles cannot reach. Additionally, many NGOs employ nurses who are not familiar with tribal customs and languages specific to the areas we reach which inhibits their ability to discuss sensitive topics such as family planning, female genital mutilation, and HIV. By utilizing camels as a means of transporting medicine for nurses & counselors from the same tribes as those we serve, NCT overcomes two primary barriers in providing health to these populations: physically reaching them despite lack of roads and understanding the language and culture to successfully educate and provide services for reproductive health and HIV/AIDS.
Delivery Model
NCT trains and employs staff from local communities to ensure that they are familiar with the customs and languages of the following tribes: Samburu, Masaai, Turkana, Kikuyu, Borana, and Meru. A team consisting of two counselors, a nurse, camel-handlers, and occasionally a pharmacist makes trips that range from a few days to three months in order to deliver door-to-door services to the various remote communities in the district. They travel using four-wheel drive vehicles, camels and bicycles; the camels and bicycles are used to ensure the staff can reach communities that are not accessible by road.
In addition to our immediate staff, which includes nurses, a health worker, a driver and counselors, NCT supports Community Based Distributors (CBDs). These are community members who have been nominated by their own community and are paid on a contractual basis for their Family Planning & Counseling and Testing work. NCT works with the Ministry of Health in order that the CBDs and their communities may become self-sustainable in the future. These CBDs work as “field agents” of the mobile clinic and help ensure that clients in their respective communities are aware of the clinic’s schedule; they also assist with dissemination of clinic information. Many have now become education officers and/or family planning counselors.
Nomadic Community Trust receives approximately 50,000 visits in Samburu District and 70,000 in the Laikipia annually. This data is based upon 7 years operation in Laikipia and 2 in Samburu. Very accurate records have been kept and measure the details of every visit that enable us to record our impact.
Key Operational Partnerships
Nomadic Community Trust has a strong partnership with the Kenyan Ministry of Health (MOH) which help by providing in kind support such as a condoms, immunizations, birth control, and HIV testing kits. In addition to the in-kind support from the MOH, the Center for Disease Control and Prevention (CDC) has awarded NCT three years of funding (subject to vary in amount by year) that began in 2005. These partnerships are central to our initiative because, without funding, we are incapable of operating and, without support from the MOH, it would be unfeasible to see empower the communities to link directly with the MOH in the future in order to ensure their long-term sustainability.
Impact
Financial Model
Because Nomadic Communities Trust serves the most truly impoverished populations, it earns no income from its services. NCT does charge patients a token fee (usually less than $0.20) but this is often waived as “charity” when the patient is incapable of paying even a minimal amount. The fee is used to encourage patients to take responsibility for their health rather than to turn a profit. In the same vein, communities often supply counselors and nurses with gourds of milk and the occasional goat as a form of payment to show their appreciation for our services.
Therefore our entire budget is dependent upon grants, primarily from PEPFAR via CDC or USAID, charitable donations, and in-kind support from the Kenyan Ministry of Health.
What is your annual operating budget?
200K
What are your current sources of revenue? (please list any sources that are foundation grants)
CDC awarded us a 3 year funding of PEPFAR money that varies each year (currently they have pledged 250,000 for 2007) that began in 2005 but is only used for HIV programs and none in Reproductive Health (including immunizations). Family Health International has recently supported the Laikipia section of the clinic with $50,000 USD for July ’07 – July ’08. Private donations vary each year but rarely exceed $50,000 USD except in extremely rare circumstances.
Effectiveness
NCT has proven to be remarkably effective since its conception as Mpala Community Trust in 2000 in the Laikipia district, which spawned its expansion into Samburu under the name “Nomadic Communities Trust”. The combined area of coverage for both the districts is approximately 30,000 sq km of which the majority is very remote regions. To date, the clinic has had over 1,000,000 visits and, in the past two years, has averaged approximately 100,000 visits annually (initially the clinic started much smaller).
NCT has been extremely effectual through its health education in influencing traditional practices. Notable success over the past few years include:
• Over 90% of children under the age of 5 have received vaccinations in Laikipia
• Over 5,300 women have started birth control with over 6,000 return visits
• Approximately 3,000 – 4,000 people are counseled and tested for HIV per year
• Tribes are using multiple knives, antiseptic, and gloves when performing circumcision ceremonies. Though they still practice Female Genital Mutilation, some tribes are slowly turning away from the time-honored tradition after being educated through our counselors about the dangers of FGM.
Which element of the program proved itself most effective?
Nomadic Community Trust has become a recognized name in the field and something that is considered dependable amongst the communities. By incorporating Community Based Distributors with our clinic, the communities know the exact dates of when the nurse will arrive for that month and the clinic is always aware of any movement amongst the nomadic groups. Because NCT works with the communities rather than alienating their culture as something detrimental to their health, it has been enormously successful in getting behavioral habits to change – condom use, antenatal care, family planning, HIV testing, and better practices during circumcision have all occurred because of the constant health education the clinic provides the communities in addition to its services.
Recently, NCT community Counseling & Testing Counselors have created and formally registered Support Groups For People Living With HIV/AIDS (PLWHA). NCT supports these groups by offering them medical service, counseling, education, and teaching them how to apply for grants through the local governments in order to create microfinance projects for themselves. The creation of these groups spawned out of a desire to have Positive community members empowered rather than simply dependent upon others. NCT works closely with but does not run these support groups because they are a crucial step in communities finding sustainability without dependence upon NCT in future decades.
Overall, in regions where other NGO’s fail to last, NCT has created a system where communities feel invested in their own health and also can rely upon an organization to visit them at scheduled dates and be understanding to their traditions. This has been the source of NCT’s success – working at a grass-roots level to solve the problems that have deterred larger organizations.
Number of clients in the last year?
Last year NCT had a total of 50,759 visits in Laikipia and 50,010 in Samburu for a total of 100,769 visits. Of these visits:
• 7,582 for HIV testing & counseling
• 5,304 for reproductive health (immunizations, family planning, antenatal care)
• 6,622 for curative health (basic healthcare)
• 81,261 visits for reproductive health and HIV/AIDS education
What is the potential demand?
There is enormous potential to expand & replicate the Integrated Mobile Health Clinic model within any poor, rural area where camels are found and people are not served due to remote location. In Laikipia and Samburu alone, there are an estimated 300,000 men, women and children who are yet to be reached.Our first step in expanding services, as noted here, is to grow within these two remote regions.Contingent on future funding, additional districts for expansion include:
• Baringo – area 8,646 sqkm;avg. daily income 20ksh ($.014/day); population of about 265,000;
• West Marsabit – area 66,000 sqkm; 80% pastoralist area, population of about 121,500
More importantly, the basic structure of the can be replicated in any remote and largely inaccessible regions throughout world. The concept is relatively simple: utilize local people and load-bearing animals to provide direct healthcare to communities that need it most and create a schedule that is strictly adhered to, in order that the communities know what day each month the nurse will arrive. This way, a mobile clinic can maximize the amount of people it reaches and leave the community with skilled members who can offer continued health services and education. Other load-bearing animals such as donkeys or horses could easily replace the camels. This way, all communities throughout the globe, whether in the mountains, desert, or rice paddies, can access services formerly unavailable to them - especially childhood vaccinations, a recognized universal right.
NCT has already proven how it can effectively scale up by introducing the Samburu clinic after 5 successful years, yet it should not be limited to these two regions or even to Kenya alone. Every rural community can and should benefit from this unique approach toward provision of healthcare. The advantage of NCT is that it has been working for six years and has gained a strong sense of what works best and what should be avoided.
Scaling up Strategy
In the next three years our priority will be to strengthen our programs and to possibly expand into the Baringo or Western Marsabit districts (dependent upon funding).
We will encourage and assist the PLWHA groups to use their network to allow the members to access Antiretroviral Therapy which currently is not feasible because of their poor diets, lack of access to hospitals and CD4 count machines, and uncertainty of adherence to the drug regimen. By empowering these support groups, they can create the social & financial network that will allow them to overcome these obstacles, using microfinance to pay for their diet and transportation to hospitals and using their social network to help one another adhere to the drug regiment and encourage others to be tested. Thus, the support groups will not only help themselves but also continue to reduce the stigma surrounding HIV/AIDS in the communities.
In addition, we want to continue to educate on the advantages of reproductive health - especially family planning. Looking at our figures, we have learned that it takes approximately 2 to 3 years before the concept of family planning really is accepted, however, the acceptance among women is crucial. In communities where girls are married as young as 12, women are constantly pregnant, infant & maternal mortality is extremely high, and poverty is ever-growing, family planning is absolutely crucial. Thus women can space their children to allow them to recover from the pregnancies and have healthier infants and are able to provide for their children better.
Overall, we want to continue to strengthen our integrated reproductive health and HIV/AIDS services and education to ensure a lasting impact. Should we have increased funding, we would begin our programs in neighboring districts.
Stage of the initiative:
0
Expansion plan:
Our expansion is dependent upon funding and, in order to be most effective, will be limited to the districts we know in Northern Kenya. However we hope that our model will receive enough recognition to be repeated by others throughout the world. Given that its success is based upon utilizing local knowledge & personnel, we know it would not be practical for us to expand to regions outside our scope, but would rather want to see our model replicated. As we progress, we have learned many lessons and, as we expand our services, we have gained a wealth of knowledge about how to best organize & deliver such health and education in the most effective manner.
Origin of the Initiative
Nomadic Community Trust was created after the founder, Sharon Wreford-Smith (Kenyan), recognized the unsustainable population growth resulting from lack of knowledge about and access to Reproductive Health services for the nomadic communities in Northern Kenya where she lives. She created the mobile clinics primarily for reproductive health services and education, and included HIV/AIDS services because she recognized the prevalence of the disease in the area and its impact on women’s reproductive health. From there she began to incorporate HIV testing and counseling and curative treatment into her original model. The clinic has grown organically by responding to the needs expressed by communities. By allowing the communities to identify potential counselors & other areas in need, NCT has successfully grown and without losing its grass-roots origin.
This Entry is about (Issues)
Sustainability
What are your two main challenges to finance the growth of your initiative
The major challenge is simply finding funding through grants. Because our operation is aimed at helping the poorest of the poor, we cannot be financially stable without having our work supported through partnerships and funding. As a result, we sometimes find our work has to be tailored to the wishes of our funders, for example, CDC will only give us money for HIV/AIDS while neglecting reproductive health programs including things as crucial as immunizations. Because of financial uncertainty, we find it crucial in building up the communities so, should our work end for lack of funding, they have the skills & resources to ensure our work can continue in some capacity. This uncertainty is another reason we cannot offer life-long therapy such as Antiretroviral Therapy for HIV patients in the event we leave and then patients no longer have access to the drugs, there is possibility of ARV resistent strains of HIV emerging in the region.
How did you hear about this contest and what is your main incentive to participate?
We were contacted and asked to enter after we made the finals of the World Bank Development Marketplace Competition.
The Story
Do you have an annual financial statement?
Yes and they can be provided if necessary
Do you currently have an annual financial statement that tracks profit/loss?
To implement in a new district is approximately $250,000 USD. Once established, the program can run on anywhere from $150,000 to $250,000 each year. The extent of the programs is based upon funding.
Please describe the amount (and/or type) of funding you need to implement your initiative, at year 1 and at year 5.
This field has not been completed
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Comments
Congratulations on your program!
I am curious as to your sources of essential medicines for the program. Are they donated in kind by government or other, or are they purchased? If so, from whom? How do you achieve the best quality at lowest cost?
Thank you
Nora El Goulli
Hi Nora,
Thank you for your support! As for medicines, we purchase the majority through Mission for Essential Drugs and Supplies (MEDS) which is largely recognized in Kenya to be the highest quality at lowest cost supplier of medicines. The government supplies us with vaccinations, HIV testing kits, condoms, and occasionally mosquito nets. Unfortunately, a large amount of budget goes to the purchase of medicines, so we are always looking for possible routes to either donated medicines or other options. Until then, MEDS is our primary provider.
Hope that is of help!
-molly fay
This is such an interesting picture.
Thank you, I hope I can load some more on this website, but internet connection is slow in Kenya. Still, you can see a more comprehensive selection at our website: www.nomadictrust.com if you are interested in seeing photos of the communities with which we work.
Thank you so much!
Hi Molly!
Your program sounds terrific, and it is a model that could be replicated in many countries where road infrastructure is weak. But my concern is that because you are currently almost 100% dependent on donor assistance, how sustainable will this project be if donor funding dries up? Does your organization have any plans to move towards a model that will allow you to create an income stream? Or perhaps to be encompassed into the national health system? Would love to hear more about it if there is indeed such plans.
Thank you for your participation, and your response!
Best,
Tyler Ahn
Changemakers
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
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