AMREF PROGRAMME IN KITUI COUNTY, KENYA. PRESENTATION TO AMREF INTERNATIONAL BOARD MARCH 3RD, 2014

Denge Lugayo, Project Manager

Mwi athokye muno! 2

Map of Kitui County

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About Kitui County Population of 1,660,709  Women of child bearing age (15 – 49 Years) = 254,517  Children under 5 years = 175,529 • Total HHs: 398,709 • Number of Sub Counties: 16 • Semi arid, unreliable rainfall • Access to safe water – 30% • Access to basic sanitation – 78% • Malnutrition  Wasting – 33%  Stunting – 43% • Skilled Deliveries – 40% • 4th ANC Attendance – 28% •

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Poverty Level: 57%

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AMREF PROJECTS 1. Integrated Water, Sanitation and Hygiene Project – 1998 to date  1998 to 2005: Funded by AMREF Italy  2005 – 2011: Co-financed with EU & AMREF Italy  2011 – 2016: Funded by AMREF Italy 2. Water for Improved Nutrition and livelihoods Project  March 2012 – August 2016; Financed thro’ AMREF Germany 3. Maternal Newborn and Child Health Project in Mwingi Sub County.  2013-2017; Financed by EU and AMREF Italy. 4. Aphiaplus Kamili -Social Determinants and OVC /HBC Project.  2011 – 2017; USAID thro Consortium partners. 5. KAVES – Kenya Agricultural Value Chain Enterprise Project  2013-2017; funded by USAID thro’ FINTRAC

These projects provide different entry points into the community while leveraging on each other’s resources ultimately leading to the improvement of the health status of the people in Kitui County.

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KEY I-WASH ACTIVITIES 1. Increase access to safe water - Development of water sources e.g. Shallow wells, Boreholes, Sub surface dams • 1141 conventional wells. etc • 21 Giant Wells. • 14 Boreholes developed. • 6 Sub surface dam developed. • 144 Km water pipeline extensions done • 40 Rain water harvesting tanks

•Well digging in progress

• Completed well with hand pump installed

KEY I-WASH ACTIVITIES 2. Increase access to sanitation &Hygiene in schools &

households. • 33 standard classrooms •1 52 VIP latrines in schools & households • 20 Ecosan toilets • 260 Refuse pits, Dish racks & HWFs installed in schools and at HH levels.

• CLTS - Village triggering session

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•TOTs training children on proper Hand washing with Soap.

3.Improve Nutrition and Livelihoods for communities

• 10 Farmer groups supported to grow DTCs varieties, vegetables & fruits. • 3 Green houses installed • 5 Drip irrigation Kits installed • 327 groups members trained on value chains and marketing.

Tomatoes in a Green house

Vegetable & fruits around water sources for Nutrition & livelihoods

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3. Increase demand and utilization of MNCH services at community & facility level.

Water tank

Hand Washing Station Sanitation facility - latrine

Improved WASH services for 5 Health Facilities • Improved water supply  Training of HFC  Train CHVs  Training & supporting CHEWs  Follow up & Monitoring of CHVs

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Improved toilets - separate for both sexes. Construction of incinerators, placenta pits & hand washing stations. Improved maternity Services. Improved patients waiting area

Increased utilization of Health Services

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Key Results/Outcomes • • • •

Access to safe water increased from 28% in 2006 to 82% in 2011 Latrine coverage increased from 37% in 2006 to 78% in 2011 Hygiene Practices – Hand Washing with soap at 87% Walking distance to primary water source reduced from 10km to 2km. • Multiple Use Services (MUS) of water by over 60% of Water Management Committees (WMCs) and 10 farmer groups. • Reduced school absenteeism and increased retention. • Skilled deliveries from 40% to 65% • 88.5% of children under 1 year fully immunized. • Percentage of mothers with infants who attended ANC clinic at least 4 times before delivery currently at 68% • Improvement of nutrition status among children with a reduction of severe acute malnutrition from 5% to 1% 10

Challenges • Frequent drought (results in Drying of water sources) • Few and far located health facilities (Deter health seeking behaviour) • Limited supplies of commodities; (Essential drugs and equipment for MNCH & SRH) • Weak referral system; (Poor infrastructure & lack of transport) • Lack of water & sanitation in health facilities (Under utilization of HF; skilled attended deliveries, ANC and immunization) • Low-male involvement in WASH & RH issues. • Motivation & Retention of Community Health Volunteers (VHCs) • Harmful religious/cultural beliefs and practices:‘Kavonokya’(Deter uptake and utilization of health services)

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WAY FORWARD • Strengthening Integration (WASH, MNCH & Nutrition) • More Partnership - More fund raising efforts with FARM Africa, County Government, AMREF National Offices (Germany, Italy) and other partners including Knorr Bremse – Global Care, Stern Stunden of Germany. • Investing more in innovative water conservation technologies such as Sub Surface Dams to recharge under ground water. • Document Integrated WASH & Water for Nutrition models and share with other AMREF Offices. • Advocate for more male participation in WASH & MNCH services.

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A Shallow Well – Ideal for 20-25 Households

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School Health – Safe & hygienic learning environment for children.

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ASANTE SANA