HEALTH & NUTRITION Kenya Programme

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1 HEALTH & NUTRITION Kenya Programme

About Us Save the Children has been operational in Kenya since the 1950s, providing support to children through developmental and humanitarian relief programmes delivered both directly and through

2 About Us Save the Children has been operational in Kenya since the 1950s, providing support to children through developmental and humanitarian relief programmes delivered both directly and through local partners. Current Save the Children programming in Kenya focuses on Health, Nutrition and WASH, Child Protection, Child Rights Governance, Education and Child Poverty. In 2012, as part of a global reorganization process, Save the Children combined the programmes of SC UK, SC Canada and SC Finland to create a single operation in Kenya. In February 2014, we completed a second transition, which saw us join forces with the British INGO, Merlin, and merge their health and nutrition programmes with our own. Save the Children has an operational presence in Bungoma, Busia, Garissa (Dadaab Refugee Camp), Mandera, Nairobi, Turkana and Wajir counties and works through partners in many other parts of the country. Our Theory of Change Our approach to programming is driven by our Theory of Change. Being the voice: We advocate and campaign for better practices and policies to fulfil children s rights and ensure that children s voices are heard (particularly those of children We will be the voice most marginalized or living in poverty. Being the innovator: We develop and prove evidence based, replicable breakthrough solutions to problems facing children. Achieving results at scale: We support effective be the innovator build partnerships implementation of best practices, policies and programmes for children, leveraging on our knowledge to ensure sustainable impact. achieve results at scale Building partnerships: We collaborate with children, civil society organizations, communities, governments and the private sector to share knowledge, influence others and build capacity to ensure that children s rights are met. Our health and nutrition work in Kenya Save the Children s approach to health & nutrition programming employs a 3-pronged approach: Working with communities to create sustainable demand for and improve access to quality services and to hold their duty bearers to account Working with the Ministry of Health through a system strengthening approach to build human and institutional capacity to provide quality health services Advocating for an enabling policy and resource environment Our thematic approach focuses on scaling up of evidence tested high impact interventions across the continuum of care for Reproductive Maternal and Newborn Health, Child Health, Adolescent Sexual Reproductive Health and Maternal Infant and Young Child Nutrition

Our current strategy: 2016-2018 In the period 2016 to 2018, we will provide technical and programmatic support to 15 high priority counties to scale up the evidence-based high impact interventions

3 Our current strategy: In the period 2016 to 2018, we will provide technical and programmatic support to 15 high priority counties to scale up the evidence-based high impact interventions for maternal, newborn and child health. What is our global breakthrough for health? By 2030, no child dies of preventable causes before their 5th birthday. What do we want to achieve in Kenya by 2030? A reduction in child mortality rates at national level from 54/1,000 to 24/1,000 working with the MoH and likeminded partners What is our target for ? For 15 focus counties : At least 50% of deliveries are conducted by a skilled attendant Essential newborn care services are provided at scale A 30% increase in contraceptive prevalence rate At least 70% of children with fever or symptoms of acute respiratory illness and with diarrhea receive appropriate care from a trained health worker 80% of children are fully immunized at 1 year A 50% reduction in stunting and wasting Disaster prone counties develop a costed emergency preparedness and response plan and contingency plans Which children will we target? Children under 5 in the most deprived areas in Kenya including: Arid and Semi-Arid Land areas (ASALs) Refugee and Internally Displaced Persons (IDP) Urban Informal Settlements Our cross thematic interventions Our programmatic support will be continue to focus on innovative approaches to scale up evidence-based high impact interventions for children across the continuum of care from pre-pregnancy through to 5 years of age and from the household and community to facility level. We will put emphasis on strengthening social accountability mechanisms that enable communities to hold duty bearers to account. We will proactively seek and employ approaches that promote community empowerment and seek for community led solutions to improving health care for their mothers and children. We will continue to work with the Ministry of Health through a system strengthening approach at both national and county level. At county level, our priority will be to support the equitable scale up of: Reproductive, Maternal and Newborn Health (RMNH): Family planning, emergency obstetric and newborn care and essential newborn care. Child Health: Integrated community case management and Immunization. Nutrition: Addressing basic and underlying causes of malnutrition to reduce stunting and wasting. Water, Sanitation and Hygiene (WASH): as an integrated intervention into health and nutrition at household, community and facility level. Adolescent Sexual and Reproductive Health: Supporting provision of quality responsive sexual and reproductive health services for very young adolescents (10-14) and older adolescents (15-19) We are strategically targeting the most deprived and marginalized areas of the country that experience the highest rates and numbers of maternal, neonatal and child deaths. Only by addressing inequality can we ensure the elimination of preventable deaths of mothers and children in Kenya Duncan Harvey, Country Director, Save the Children Kenya.

Our health and nutrition work in Kenya Working with communities Working with communities is at the heart of what we do and our work at community level is driven by and anchored in the Kenya Community

4 Our health and nutrition work in Kenya Working with communities Working with communities is at the heart of what we do and our work at community level is driven by and anchored in the Kenya Community Health Strategy (CHS). We support the set up of community health units (CHUs) to functionality through the establishment of Community Health Committees and development and training of community s own resource persons notably the Community Health Volunteers (CHVs) and the Community Health Extension Workers (CHEWs). We are working with a network of 2,500 CHVs and over 300 CHEWs across our programmes. We are proactively using sustainable approaches for mobilizing communities to support positive behavior that promotes uptake of high impact interventions across the continuum of care. Some of our work includes: Working with men through a gender transformative approach to encourage their participation in improving the health of their partners and their children. Working with religious leaders to promote sustained healthy behavior such as exclusive breastfeeding, male involvement and healthy timing and spacing of pregnancy. Engaging traditional birth attendants as change agents working as birth companions. Seeking sustainable ways of incentivizing CHVs through supporting the set up of income generating activities and village savings and loans activities. Employing peer to peer mechanisms to support sustained positive behavior change through mother to mother support groups (for pregnant and lactating women) and women s groups (bringing together women of reproductive age). Supporting the Ministry of Health We are working with the MoH to support a total of 240 health facilities across our programmes. Some of our work in this area includes: Improving service delivery: support for integrated outreaches in marginalized and pastoral communities, promotion of integrated health service delivery to reduce missed opportunities and strengthening quality of care including cultural acceptability and responsiveness of health services to the community. Strengthening human resources for health: through training and capacity building, clinical mentorship approaches for skills transfer and onthe-job training, provision of long term training scholarships for nurses and midwives. Strengthening commodity supply: through building capacity in quantification and forecasting as well as storage, rational drug use and tracking of essential commodities medicines, medical consumables and vaccines. We also procure basic medical equipment for health facilities. Improving the availability and use of quality data for decision making: promoting the availability of quality data through regular spot checks and data quality audits and the use of data for decision making through data analysis and review meetings. Supporting the county and sub-county health management teams in their role as stewards of the health system: through provision of support for regular joint support supervision missions and the set-up of coordination mechanisms such as health stakeholders forums and technical working groups.

Advocating for an enabling environment Through our advocacy work, we aim to be the voice for children especially in areas with the most deprived children in Kenya.

Monitoring, Evaluation, Accountability and Learning (MEAL) systems and by our research.

5 Advocating for an enabling environment Through our advocacy work, we aim to be the voice for children especially in areas with the most deprived children in Kenya. Our approach to advocacy is based on the following key principles: Evidence (research and policy): drawing directly on our programmes and nformed by evidence and best practices generated by our Monitoring, Evaluation, Accountability and Learning (MEAL) systems and by our research. Influence (media and advocacy): Engaging all form of media aiming to catalyse public opinion and influence decision makers to bring about change. Outcry (mobilisation): mobilising children and communities, in partnership with civil society and like minded organisations to hold duty bearers to account in meeting the rights of children. Being the innovator: Using mobile technology to promote health & nutrition According to the Communications Commission of Kenya, mobile penetration in Kenya is approximately 80% with at least 2 mobile phones available for every household. For this reason, we are using mhealth to support health workers and CHVs in their work with communities. In Wajir, in partnership with Dimagi, mobile technology is being used by health workers to support in the identification and management of acute malnutrition. This application also allows for collection of real-time data improving availability of quality data for decision making. In Nairobi, working with AMREF, we are piloting the use of e-learning through mobile phones for CHVs through an SMS-based self learning system as an add-on to the current classroom based learning. In Bungoma and Busia, working with Dimagi, a digital mobile based version of the MoH community based data collection tool is being used by CHVs and this also acts as a job-aid to support them during household visits. In Mandera, mobile technology is being used by CHVs and health workers for data collection and as a cross-learning and information sharing platform between CHV and the CHEWs. Building partnerships: Engaging Traditional Birth Attendants (TBAs) Within the Formal Health System Kenya s Reproductive Health Strategy promotes the use of skilled attendants at delivery. We are working with TBAs as change agents and birth companions. Having undergone a 3-day orientation as birth companions, they identify pregnant women in the community and encourage them to deliver at a health facility. They accompany them and stay with them throughout labor and delivery. Due to their influential nature, they are also able to tackle some of the cultural issues related to early initiation of breastfeeding and harmful cord practices. Save the Children is working with a network of over 400 birth companions and is now advocating for the facility managers to use Free Maternity Funds to provide transport reimbursement to them.

6 Partnerships cont d Strategic partnerships enable us to achieve more for children. In addition to the MoH and our INGO partners, we work with research institutions such as Population Council and APHRC and corporate partners such as GSK, Reckitt Benckiser, Wrigley s, Unilever, Comic Relief, Safaricom and Philips. For example, through our partnership with GSK, we are supporting the MoH in the scale-up of interventions for newborn health such as Kangaroo Mother Care and Chlorhexidine for cord care. Working with Reckitt Benckiser has enabled us to provide handwashing facilities for communities in Turkana County while our partnership with Unilever has supported our advocacy campaign work to raise awareness and mobilise support on ending preventable child deaths in Kenya. We are working with Phillips to test a simple tool in Turkana county that will aid in accurate counting of respiratory rates and will improve the diagnosis and early management of children with pneumonia. Working with Wrigley s, we have been able to provide school health and nutrition interventions such as WASH facilities, training on menstrual hygiene to 25 schools in Nairobi and Kiambu counties. Be the voice Citizen hearing The citizen s hearing is a platform that brings together the community and government leaders to listen to and act on the views of citizens on national priorities. In partnership with World Vision, a citizen hearing was held in Turkana county bringing together community members, faith based organisations, area chiefs and subchiefs and representatives from the County Ministries of Health and Education. The main discussion points were related to issues affecting the health of mothers and their children as well as the rampant poverty and insecurity in the county. At the end of the day, a petition was signed by those present and presented to the representatives of the county government. Similarly in Bungoma, working with Kenya Alliance for Advancement of Children s Rights (KAACR), a citizen s hearing was held with the participation of the County First Lady, the County Women s representative and a few members of Bungoma s County Assembly. The Governor of the Bungoma Chapter of the Junior Assembly, aged 12 years, challenged the politicians who were present, stating that it is not time for talk, it is time for action. The meeting culminated in the signing of a memorandum with priority actions including child protection, legislation on nutrition and tackling of the jigger menace. Acheiving results at scale Scaling up Kangaroo Mother Care (KMC) Edith Wamalwa and her husband Emanuel, are casual labourers in Bungoma town. Their first born son was born weighing 1000g and was put on KMC. This is her story: I was 6 months pregnant when I became sick and went to hospital. I gave birth to a baby boy weighing 1000gms and because he was sick, he was taken to the nursery, he reduced in weight to 800grams. When the baby was stable, I was introduced to KMC and I started placing my baby in Kangaroo position (on the chest between the breasts). My baby gained weight to 1.4kg within 2 weeks. I was later discharged from hospital and I was advised to continue providing KMC at home. While at home my baby was on my chest all the time even when doing other household chores like cleaning utensils. The only time my baby was not on my chest is when I was taking a bath or visiting the toilet. This is when my husband Emanuel would take the baby and place on his chest in Kangaroo position and he supported me by putting the baby in Kangaroo position when he was in the house. This helped in bonding between him and the baby. My baby is now 6kgs and doing well. Save the Children is supporting the scale up of KMC in Kenya. We are working with partners such as UNICEF to provide technical support to the Neonatal, Child and Adolescent Health Unit (NCAHU) at the national MoH to put in place the necessary framework for scale up of KMC in Kenya. We are also providing technical support to partners who are supporting MNH programmes through facilitating attachment of staff to the KMC centres, through learning visits and through provision of our staff for training on how to set up and provide KMC.

7 Save the Children - Kenya Country Programme Matundu Close, Off School Lane, Westlands P.O BOX Nairobi,Kenya Tel /1028/1032/ info@savethechildren.org Website: kenya.savethechildren.net

Saving Every Woman, Every Newborn and Every Child

Saving Every Woman, Every Newborn and Every Child World Vision s role World Vision is a global Christian relief, development and advocacy organization dedicated to improving the health, education and protection