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Adopting new health delivery strategies for populations displaced by conflict in South Sudan

 

From 2009, Action Africa Help International (AAH-I) has been working with various development partners in implementing a regional health care programme in South Sudan. 

 

The conflict and instability in 2016 in the Greater Yei River State covering Lainya, Kajo Keji, Morobo and Yei Counties not only resulted in ruining of livelihoods for the local communities, but also in destruction of health infrastructure and looting of health facilities. For example, solar panels installed in health facilities in Morobo, Yei, and Mundri West under the solar project funded by Bread for the World and water supply systems installed in some of the health facilities were all looted. Over 80% of health facilities became inaccessible and non-functional since health workers were displaced. Most of the population was displaced to the town and some trapped in the villages. With over 80% of health facilities closed there was essential no basic services to the displaced populations

 

 


Relocating displaced health workers, working with religious leaders, local chiefs and political leaders, using temporary and mobile clinics, establishing temporary cold chains in church premises, seeking alternative routes for delivery of supplies 


 

To respond to this challenge, AAH-I adopted new strategies for continuity of the delivery of health services to internally displaced people (IDPs). We strengthened the few remaining health facilities by relocating displaced health workers to functional health facilities. Working with religious leaders, local chiefs and political leaders, a new health services delivery model was adopted through the use of temporary and mobile clinics to keep up with the movement of population. Chiefs supported the mobilization of communities for services and delivery of supplies in areas that were inaccessible. Negotiations with political leaders and the military ensured delivery of health services for IDPs in rebel-controlled areas in Kajo Keji County. To ensure availability of immunization services, cold chains were also temporarily established in church premises especially in Lainya County. Alternative routes for delivery of supplies were explored and supplies for Kajo Keji were delivered via Uganda after negotiations with authorities in both South Sudan and Uganda. Additionally, positions within the health facilities have been filled with qualified cadres and workers trained in partnership with development partners – with the International Medical Corps in Yei Health Science Training School and with the South Sudan Ministry of Health at Kajo Keji School of Nursing.

 

The 2017 mid-year review of the health project highlighted how these significant investments and improvements continue to ensure that health facilities have basic equipment and infrastructure, and that minimum standards of quality health care are observed. In the period from November 2016 to June 2017, these innovations ensured access to health services for the population in need, especially through the 124 AAH-I-managed health facilities - 5 Hospitals, 28 primary health care centres and 91 primary health care units.  

 

 

AAH South Sudan Health

Attending to a patient during a mobile clinic outreach session 

 

Achieving impact

As at June 2017, 4,535 pregnant women accessed at least one antenatal care service and 1,065 pregnant women delivered in health facilities. Out of these, 818 were attended to by a skilled birth attendant. 3,895 children aged between 0 and 11months received the third immunization dose of DPT-HepB-Hib. Growth monitoring was conducted for 15,759 children under 5 years. 661 of them were identified as malnourished and attended to. Additionally, 37,713 children under 5 years accessed curative consultation services while 93,856 of population above 5 years accessed curative consultation services.

 

It has been difficult for my community to access essential health services since the beginning of the crisis in Yei. Now our disadvantaged population - children, pregnant mothers, elderly and the disabled can access health services in Kukango Static Clinic. Even people trapped in areas outside the town like Lun, Payawa and Alero come through the bushes to seek services in the clinic. The good news is that they always get services and go home with some medicine,” said Justin Diko, Ronyi Boma Chief, Yei Town Payam, Yei County.

 

Ensuring that we are on track: Monitoring projects in Turkana County, Kenya

 

To provide support to the Kakuma project implementing team, Action Africa Help International (AAH-I) Programme Officer Rose Muthama together with Finance Manager Martin Kabutu visited Kakuma in Turkana County from 24 to 28 July 2017. AAH-I Agriculture Project Officer Peter Cheptumo facilitated the tour.

 

The projects under review during the visit were the Kakuma Refugee Assistance project (KRAP) project and Support Protection and Assistance of Refugees in Kenya (SPARK), implemented by AAH Kenya. KRAP is funded by UNHCR and SPARK by UK Aid/DFID. Both projects are supporting refugees and host communities in agriculture farming and business activities for self-reliance and improved livelihoods. The team visited AAH-I-run Choro farm and the Social Services center.

 

At Choro farm, the team witnessed 120 farmers participate in a hands-on training on the installation, use and maintenance of drip irrigation systems. The farmers learnt how to instal a drip irrigation system and a pipeline, and how to elevate water tanks on stands. Farmers were also trained on protecting drip lines, connecting cut drip lines using drip connectors, regular cleaning of filters and regulation of water supply to farm blocks. Choro is a 9-acre farm owned by refugees and the local Turkana host community. It comprise 5 acres under KRAP and 4 acres under SPARK. The 5 acres under KRAP consists of 3 acres under 2016 funding  and currently under vegetable production, and additional 2 acres under 2017 funding and together with 4 acres under SPARK are under development stage for crop production. The training was facilitated by Joseph Muttundu, a technician from Sunculture. Sunculture have been contracted to instal the drip irrigation system at the farm. 

 

 

AAH Kenya Drip irrigation training

Farmers being trained on the use and maintenance of a drip irrigation system

 

 

During the training, Turkana County gender and social development officer Rugar P. H. Ronoh sensitized the farmers on climate change and its mitigation against crop loss and disaster.

 

 

Strengthening local community structures

The next stop of the monitoring visit was at the social services centre for the election of a management committee to oversee activities at Choro farm. The objective of setting up a committee is to strengthen and enhance sustainability of the agriculture project. The committee will be the umbrella group that will oversight and support management of the entire farm. Participants at the election were representatives drawn from the 20 beneficiary farmer groups working on the farm. Rugar P.H. Ronoh from the Turkana County government was invited to oversee the election. “The success of any working group lies on good leadership and support from members,” he said.

 

To kick off the voting, he briefed members on important aspects of group formation and related requirements of farmers’ group registration and the importance of having a Group constitution and by-laws. Participants also discussed group dynamics and leadership, conflict resolution and management, resource mobilization and formation of cooperative societies.

 

Farm management committee elections

Abdul Aziz Lugazo from Somalia was elected Chairperson. He is from Hari Mpya farmers’ group. Mary Asekon Engomo and Peter Ewesit, both Kenyans from Narongor farmers’ group were elected Vice-Chairperson and Secretary, respectively. Bernadette Chambikwa from the Democratic Republic of Congo (DRC) and Mapendo farmers’ group was elected Vice Secretary while Akuol Mading from South Sudan and Green Garden farmers’ group was elected Treasurer. James Adilan from Sudan, Ewoton Emoja from Kenya, Lochata Ekidor from Kenya and Sofia Makongo from DRC were elected Members. They are from Wadi Azom, Nyajokon and Umoja ni Maendeleo farmers’ groups.

 

 

AAH Kenya Choro Farm management

From L to R: Peter Ewesit, Bernadette Chambikwa, Sofia Makongo, Abdul Aziz Lugazo, Lochata Ekidor, Akuol Mading, Mary Asekon Engomo, Ewoton Emoja and James Adilan 

 

 

“The community’s own leadership is an important foundation for project sustainability and self-reliance,” concludes AAH-I’s Peter Cheptumo.

AAH-I at Refugee Solidarity Summit

  

Uganda held the first Solidarity Summit on refugees in Kampala from 22nd to 23rd June 2017. The Summit was hosted by the President of Uganda, Yoweri Museveni and the UN Secretary General Antonio Guterres. At the end of the 2-day Summit, the international community had pledged $358.2 million of the $2 billion that the Summit hoped to raise to support the nearly 1.3 million refugees, out of which 900,000 are from South Sudan

 

Uganda Solidarity Summit logo

 

The Summit, which intended to fundraise for the refugees and showcase Uganda’s settlement approach to the refugee crisis, fell short of its funding agenda but attracted the attention of the international community to the plight of refugees. Uganda is second to Turkey in the world and number one in Africa in hosting the largest number of refugees. 

 

International nongovernmental organizations played a part in the Summit. The Uganda Red Cross was the lead organizer of the NGO participation. The theme of the NGO side event was “The role of humanitarian and development NGOs and the civil society in addressing the humanitarian development nexus in supporting refugees and host communities”. The event largely focused on investing and building the capacity of local, national actors, NGOs and civil society, to become better positioned to support refugees and the communities they live in. The NGOs raised some concerns about the support they receive to implement activities and recommended several reforms to the refugee response. They recommended:

 

  1. That support to the NGO responders should be more predictable to enable better planning and preparedness
  2. Multi-year financing is essential and should be considered. The average stay of a refugee is 15 years, while some refugees stay for much longer or become nationals. During the past 2 years, only a small number of refugees in Uganda have repatriated back to their countries. Therefore the refugee crisis ought to be seen in the longer term perspective than it currently is, hence the need for multi-year financing.  
  3. Better collaboration and coordination between the various actors.
  4. Recognition that NGOs, just like the UN, need their administration costs covered.
  5. Local organizations to increase their visibility
  6. International NGOs to include in their plans and budgets aspects of building the capacity of local organizations

 

AAH Uganda Country Director Dr. Daraus Bukenya represented AAH-I at the event. 

AAH South Sudan Board visits Maban 

 

The Chairman of Action Africa Help International (AAH-I) Board Dr. John Tabayi and the Chairman of AAH South Sudan Board, Mr. Leonard Logo Mulukwat visited Maban County for three days from 14th to 16th June 2017. They were accompanied by Innocent Asiimwe, the Project Manager of AAH-I/UNHCR Humanitarian Logistics Project. 

 

During the visit they had the opportunity to meet key stakeholders working closely with AAH-I in Maban. They also met and interacted with AAH-I staff in Maban and visited various project sites.

 

First stop was at the Gendrassa warehouse, run by AAH-I, where core relief items and pharmaceuticals for distribution to internally displaced persons are stored. The visitors commended the good organization of the warehouse. In 2016, the AAH-I warehouses in Maban and Malakal were recognized by UNHCR as the most compliant in South Sudan.

 

 /stories/images/AAH South Sudan visits Maban - June 2017

From left to right: Maban Warehouse Manager De’Mello Bageni, Board Chair AAH South Sudan Board Hon. Leonard Logo Mulukwat, Maban Area Coordinator Paul Sawo. Warehouse Assistant Chol Aguer and AAH-I International Board Chair Dr. John Tabayi 

 

The delegation also held a staff meeting with AAH-I staff in Maban. Staff were encouraged to utilize their time well by upgrading their skills through different learning opportunities, including online-based learning. The session was crowned with the presentation of Certificates of Merit for exemplary performance in Warehouse Management in 2016. The occasion was presided over by the Board Members and UNHCR Officer in Charge, Mr. Andreas Fiadorme.

 

AAH South Sudan Maban staff during Board visit - July 2017

Maban staff pose with AAH-I International Board Chair Dr. John Tabayi (4th left), Board Chair AAH South Sudan Board Hon. Leonard Logo Mulukwat (5th left) and Project Manager Innocent Asiimwe (6th left).

 


In 2016, the AAH-I warehouses in Maban and Malakal were recognized by UNHCR as the most compliant in South Sudan.

 


 

The team paid a courtesy call to UNHCR where they met the Senior Protection Officer, Andreas Fiadorme and the Programme Officer, Antonius Kamerika, and to the County Commissioner and the South Sudan Relief & Rehabilitation Commission (SSRRC) offices where they met County Coordinator Alex Bala and SSRRC County Security Focal Point Yohanes Bol.

 

AAH South Sudan, in partnership with UNHCR, is implementing logistics interventions supporting refugees, internally displaced people, host communities and other persons of concern to UNHCR in South West, North East Maban and Malakal Counties in South Sudan. 

Financial inclusion for refugees

 

At least 65.3 million people around the world have been forcibly displaced from their homes as a result of natural disasters, persecution, conflict, generalized violence, or human rights violations. According to data from the United Nations Commission for Refugees (UNHCR), 21.3 million of these displaced people are refugees, 29% of them hosted in Africa. 

 

Refugees in Africa, as is the case globally, don’t travel far from their home countries. It is estimated that about 86% of them settle in low- and middle-income countries close to their home countries. The top six refugee destinations in Africa are Ethiopia, Uganda, Kenya, Chad and South Sudan. The majority of people fleeing the crisis in Yemen have settled in Djibouti, Ethiopia, Somalia and Sudan. It is estimated that 2,800 people arrived in Uganda every day from South Sudan in March 2017, bringing the total to just over 1 million refugees at the end of April 2017. Burundi and Rwanda are hosting refugees fleeing violence, rape and killings by militias in the North Kivu region of the Democratic Republic of Congo. 

 


 Kakuma refugee camp in Turkana county in Kenya is home to at least 170,000 people.


 

One of the large refugee camps in Africa is the Kakuma refugee camp in Turkana county in Kenya, now home to at least 170,000 people. When it was set up in the early 1990s, Kakuma was thought to be a temporary settlement. About 20 years later, and with evolving priorities of funding partners, there is need for modifying the support for refugees and host communities to enable them, especially those in the working-age group (ages 18-59), to be more self-reliant. 

 

The UNHCR’s Global Trends report indicates that the proportion of refugee populations in the working-age group was at 47% in 2015. Humanitarian actors in refugee-hosting countries have for a long time contemplated the best support for refugees – in a way that can sustainably improve their quality of their lives. But recently the attention is being focused on this working-age group, with new approaches to protect their lives and dignity being taken into account. One such approach is models that offer financial products tailored for refugees.

 

The World Bank describes financial inclusion as ‘means that individuals and businesses have access to useful and affordable financial products and services that meet their needs – transactions, payments, savings, credit and insurance – delivered in a responsible and sustainable way’. Financial inclusion is considered significant in realizing for 10 of the 17 Sustainable Development Goals - No poverty (SDG 1), Zero hunger (SDG 2), Good health and well-being (SDG 3), Quality education (SDG 4), Clean water and sanitation (SDG 6) and Affordable energy (SDG 7), Decent work and economic growth (SDG 8), Industry, innovation and infrastructure (SDG 9) and Reducing inequalities (SDG 10) and Peace, justice and strong institutions (SDG 16).

 

On one hand, refugees are in desperate need of opportunities to be self-reliant. However, given their circumstances, it is not always given that they would have complete identification or guarantors or collateral to access financial products in the countries they have settled in. These factors have led to the perception that refugees are a financial risk. On the other hand, financial service providers are now assessing the risks, identifying potential advantages, and are looking for ways to best serve refugee communities.

 


According to UNHCR statistics for December 2016, inadequate livelihood opportunities in the Kakuma Refugee Camp

render 37.7% of the working-age group of refugees vulnerable to socio-economic shocks in the camp.


 

 According to UNHCR statistics for December 2016, inadequate livelihood opportunities in the Kakuma Refugee Camp render 37.7% of the working-age group of refugees vulnerable to socio-economic shocks in the camp. In Kenya, organizations such as Action Africa Help International (AAH-I), in partnership with UNHCR, have from 2015 been implementing an innovative model that allows entrepreneurs in Kakuma refugee camp, Turkana county, access business capital. Through a private sector partnership with Equity Bank, refugee entrepreneurs can access structured institutionalized micro-finance services. Group and individual businesses can receive between KES. 5,000 and KES. 100,000. So far 67 businesses ranging from tailoring, bakeries, vegetable farming and fishmongers have benefitted from the revolving fund. One of the key characteristics of humanitarian work is its impulsive nature, usually responding to emergencies. Offering financial products to refugees is seen as one way of making the sector’s interventions more responsive and sustainable. 

 

Shukurani Hota Biclere, a refugee from the Democratic Republic of Congo, is one of the beneficiaries of funds for business startups. She arrived at the Kakuma Refugee Camp in 2012, already with tailoring skills she had acquired from her home in Uvira, south of Kivu. She qualified for an AAH-I loan of KES. 100,000 for her business start-up in June 2016. Almost one year later, Biclere now boasts an average of 40 clients per month, and has employed 7 staff, all refugees within the camp. As at March 2016, she had repaid KES. 72,000 of the loan.

 

AAH Kenya project.jpg Shukurani Hota Biclere (L) with an apprentice at her tailoring business in Kakuma

 

Biclere showcases benefits of this type of conditional loans - building credit-worthiness of refugee businesses, creation of employment for fellow refugees and host community members and the stimulation of the local economy through expansion and diversification of businesses.

 

For those refugees with entrepreneurial experience or talent, small business loans are one way of getting them integrated back into normal life. As we mark the World Refugee Day on June 20th, we honour the courage and resilience of refugees like Biclere.

Inspiring story ahead of the World Refugee day.