THE FIELD TEAM

One Mobile Clinic team usually includes two nurses, a health worker, driver, and administrative assistants. CHAT and NCT have a Memorandum of Understanding (MOU) with the Ministry of Health who ensure that the team is supervised regularly. The Trusts also work with community based health care workers who provide door-to-door integrated services for HIV/AIDS and Reproductive Health Care. These include Community Based Testing and Counselling personnel (CBHTC’s) and Family Planning Community Based Distributors (FPCBD's). All health workers are drawn from their indigenous communities in the Laikipia and Samburu regions. Within the framework of "empowerment and sustainability" these community health workers are not contracted to or employed by CHAT/NCT but rather they operate independently.

CLINIC SERVICES

Methods of delivery, and the number of staff attending each clinic, varies according to road accessibility and distance. Four-wheel drive transport is used to deliver health care services to those areas in Laikipia and Samburu that are reachable by road. For communities in close proximity to Field Base camps, bicycle and foot transport are used. Camel caravans represent a more appropriate form of delivery to areas that are remote and do not have a road network. Camel mobile clinics are usually staffed with one nurse, two CBHTC counsellors, one FPCBD counsellor and three camel handlers who manage six/seven camels. Camels are a highly efficient mode of travel as they are able to transport medicine, clinic material, camping equipment and provisions. Camel mobile clinics typically spend one month in the field. Ideally they return to each community every three months to cover the HIV window period for testing and to follow up contraceptive methods for Family Planning such as Depot. Generally one mobile clinic will service up to 35-45 communities. The clinic remains for 2/3 days in each community before moving to the next location. Medical treatment and education services rendered to communities are charged at a token rate of 20 Kenyan shillings. If individuals/groups have no money then they often pay with milk or other food items.

DATA COLLECTION/MEASUREMENT/AUDITING

The NCT and CHAT clinic programmes have a well-developed system for recording and reporting data that is collected in the field. This system accords well with funding organisation requirements and with the Ministry of Health. Data collected in the field is relayed to the Ministry of Health on a monthly basis and all information is collated and stored by the CHAT/NCT data-clerk. Both NCT and CHAT have sound Governance, Finance and Human Resource policies in place. A detailed monitoring and evaluation plan for data collection is adhered to and accounts are audited regularly. The Kenyan Ministry of Health supervises the activities of both organisations on a regular basis, which allows for up-to-date information on new Government initiatives.

TRAINING HEALTH CARE WORKERS FROM THE COMMUNITY
Health workers that operate alongside CHAT/NCT comprise two categories: Community Based TC Counsellors (CBHTC)–HIV/AIDS Testing and Counselling. Family Planning Community Based Distributors (FPCBD) When The Community Health Africa Trust and the Nomadic Communities Trust are asked to provide integrated health services to a community they proceed with the following protocol for the education of CBHTC (HIV/AIDS) counsellors: 1) Mobilise the community to identify members whom they deem eligible for training in HIV/AIDS and Family Planning. Generally such individuals should have gained a pass in form four or "O" level. Efforts are made to reach a balance between male and female nominees. 2) Those individuals who are nominated by their communities are then interviewed by the Centre For Disease Control (CDC). This organisation (linked to the American Federal Government) provides financial support and training for HIV/AIDS counsellors in the "Liverpool model of Training".

3) After being trained, counsellors return to their communities and are expected to test approximately 100 people per month for which they are remunerated accordingly. Counsellors are expected to link to other health providers and implementers such as the Ministry of Health, District development offices, World Vision and CARITAS.

4) CHAT/NCT mobile teams provide ongoing support to these counsellors and their communities with monthly visits. This includes health education to the local community school.

5) Further remuneration can be gained if counsellors register a support group in their community for, but not limited to, People Living with HIV/AIDS (PLWHA's).

6) Once these support groups have been established counsellors are expected to link these groups to the Kenyan Ministry of Health and to seek out supervision from Ministry of Health personnel.

CBHTC counsellors may also be trained as Reproductive Health (FPCBD) counsellors. The procedure for identifying FPCBD counsellors is similar to that of CBHTC counsellors. However, FPCBD counsellors are not required to have a high level of education. The training of FPCBD counsellors is facilitated by the Reproductive Health Officer within the Ministry of Health. Remuneration is in accordance with the number of referrals made to the clinics for different contraception methods. FPCBD counsellors are encouraged to link with the PLWHA's support groups to implement Family Planning for Prevention with Positives (PWP). The CBHTC counsellors report to the Ministry of Health and to the CACC (Community arm to the National AIDS Project) on a monthly basis to collect materials for testing and counselling. These counsellors provide written reports to the CACC every three months). The FPCBD’s report to and are linked to the MOH for the sustainability of their programmes.

By imparting skills and health strategies to Community Based Distributors, CHAT/NCT hopes to establish a measure of continuity and sustainability for health services in remote areas that goes beyond those services supplied by the mobile clinic. Other measures to extend health care in rural communities include partnering with local chiefs, traditional healers, traditional birth attendants and other principal community leaders. The WHO states that approximately 80% of people in rural Africa seek treatment from traditional healers before seeking western biomedicine options. By mobilising support from community leaders it is believed that these community leaders will assist in expanding the networks of support and improve pathways to health care in the remote areas of Laikipia and Samburu.

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3. HEALTH SUPPORT GROUPS (which includes support groups for people living with HIV/AIDS)

The Community Health Africa Trust (CHAT) and The Nomadic Communities Trust (NCT) aim to set up Health Support Groups, which includes support groups for people living with HIV/AIDS. The Trusts  in conjunction with the CBHTC’s have been instrumental in establishing approximately 21 legitimate support groups for PLWHA's in the Laikipia and Samburu regions.

Community Based HIV/AIDS Counsellors (CBHTC) - operating in their home communities - play a pivotal role in testing and identifying individuals who are living with HIV/AIDS. These counsellors, who are given supervision from CHAT/NCT and relevant Government Ministries, are encouraged to assist People Living with HIV/AIDS (PLWHA's) to initiate support groups. Counsellors mobilise these groups towards establishing committees and linking with the Ministry of Health and other government bodies, faith based organisations and NGO's. The aim is to capacity build these support groups at a foundation level, assisting them towards a position of independent self-sustainability with their own income generating projects and partnerships. After providing the initial impetus to initiate support groups, CHAT/NCT aims to create a platform for community health management that will ultimately be self-generating with a strong leadership and management capacity.

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4. POPULATION GROWTH AND REPRODUCTIVE HEALTH

The United Nations projects that the World population will reach 9.2 billion in 2050. In Circa 1900 Africa supported a population of 133 million people, in 2050 the population of Africa is expected to reach 1.9 billion.

POPULATION GROWTH IN KENYA Kenya's population growth is advancing at an alarming rate. Currently it supports one of the fastest growing populations in Africa. In the past 80 years the population of Kenya has increased from 2.9 million to 37 million. These figures are expected to increase to 85 million in 2050. Rapid population growth is linked to a high fertility rate with the average Kenyan woman giving birth to approximately 4.8 children in a lifetime. This compares sharply with 2 children in the USA and 1.6 children in Britain and is well above the so-called replacement level of 2.1 children per woman, which would lead to a stable population size.

Amongst other factors Population growth is linked to an increase in the birth rate and a decline in the mortality rate due to medical advances. For every 10 deaths in Kenya there are 40 newborn babies (In the USA there are 14 births per 8 deaths and in the Britain 10 births per 10 deaths). Population growth in Kenya has placed enormous strain on the Government's capacity to provide healthcare, education and other services to its people. Although agricultural productivity in Kenya has grown significantly, these advances are not sufficient to meet the increased food demand that comes with exponential population growth. Many parts of Kenya are overpopulated and are heavily dependent on food aid, especially in times of drought.

OVERPOPULATION

Overpopulation is determined by using the ratio of population to the available sustainable resources. If a specific environment has a population of 50 people, but there is only enough food or drinking water for 40 people, then that specific area may be considered overpopulated. In the Laikipia and Samburu regions of Kenya the climatic and environmental conditions are harsh. The carrying capacity of this habitat is failing to support an ever-increasing number of people. The pressure on scarce and limited natural resources is intense and the situation is further compounded by drought, land degradation and over-stocking.

FAMILY PLANNING IN KENYA

Kenya was the first sub-Saharan African country (in 1967) to adopt a National Family Planning Program. This long history of population control in Kenya has showed some success. The total fertility rate now stands at 4.8 lifetime births per woman. This is below the average of 5.5 children per woman for East Africa in general. Furthermore, nearly one third of reproductive-age women are now using modern contraceptives. However, over the past decade continuous programmes for family planning have received less priority due to resources being channelled into the fight against the HIV/AIDS epidemic.

In 2005 the Kenyan Ministry of Health attempted to re-position the importance of family planning by creating a budget line for reproductive health, stating that family planning was a priority. A recently revised National Population Policy uses the targets outlined in "The Programme of action" from the International Conference of Population and Development (ICPD) held in Cairo 1994. This policy is implemented through a collaborative process that involves stakeholders from the public and private sectors, including non-governmental and community based organisations. This policy emphasises the benefits of population change for social and economic development. It also seeks to match population growth to the available national resources, thus aiming to improve the quality of life of the individual, the family and the nation as a whole.

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