BACK PACK NURSE DROP IN CLINICS

Contraceptives reduces the hefty burden of unintended pregnancies, improves service delivery and child survival, promotes smaller families, household well beings and women’s full participation in positive development efforts. Globally, over 214 million women who intend to avoid pregnancy do not use contraception leading to 90 million unintended pregnancies despite the fact that effective methods of family planning exist https://www.who.int/news-room/fact-sheets/detail/family-planning-contraception.

From our previous work, women and girls in the rural areas experience barriers in accessing Family planning due to; male chauvinism, culture of having many children as prestige, cost in terms of transport to nearby health facilities and payment for the specific method of contraceptive and lack of safe spaces for women and girls due to stigmatization by some health providers rooted in culture. This has led to many unintended pregnancies among girls and women as well as early and forced marriages in these arid and semi arid areas of Baringo County with teenage pregnancy rate of 18.4%.

We are trying to solve - the gap that exists in providing SRH services at the community level is because youth below 18 year are often discouraged form  accessing services due to cultural interference. The focus has been on adults above 18 years. This project hopes to continue to break these barriers by providing youth friendly services that are integrated with other acceptable health services at the community level. These services will help women and girls to access SRH services of their choice at a more accessible point. We also intend to reach out to men with knowledge on family planning so that they can support women and girls in these locations.

Our experience of Dandelion’s Back Pack Nurse shows that there is a high demand for family planning but in most government health facilities, long term methods of family planning are usually charged ranging from Kes 500-1000 for insertion and 1000-1500 for removal of implants and IUDs whereas private counterparts is even higher. The average distance to the nearest health centre is 18 km which means most poor people do not access SRH services. Sexual health for women and girls is elusive because of culture and lack of information, yet they report the highest number of young mothers in the region. Being a young girl with disability puts you at further risk. The number of persons living with disabilities in Baringo where Mogotio is a constituent, is calculated to be 3.1% of the population translating to 17,121 persons (2009-Kenya Population and Housing Census analytical report on persons with disability-Baringo County) majority of whom have physical and hearing disability. http://www.baringo.go.ke/images/downloads/Budget_Documents/ADP/Final-ADP-2019-2020.pdf

We set up drop-in centres in villages that are far from health facilities in rural communities (this are small spaces, simple furniture in rural villages where health services can be offered) they can be rented, or given for free by communities.

The model is simple: We train the existing community health volunteers in the different villages on mobilization strategies, the CHVs they refer women and girls to the drop in centres on the agreed specific days.

We get motorbikes and experienced nurses from the different health facilities to go to the drop-in centres and offer services to the marginalized communities, they can also go door to door to cater for those with disability who even with proximity can not get to the drop in centres.

We use a hub and spook approach where any services that can not be handled at the safe spaces including skilled deliveries and ultrasound, are all referred to a link facility like Dandelion Medical Centre or a health facility closest to the drop in centre.

This model can also take Laboratory services to the community to ensure that no child is born with the HIV virus. The Back Pack Nurse then uses his/ her phone through Open Data Kit App to collect and record all the services offered, this data then goes to the organization's database and is shared with the Ministry of Health and then it is recorded in DHIS to inform the government on the health needs of its people.

When the drop in centres are not used for healthcare on specific days, they are used to train youth who are a majority of our rural population on digital marketing, reproductive health, Village business school, reporting mechanism for gender based violence and economic sustainability strategies.

Imagine a scenario where any woman and girl, in poor resourced areas of Africa, can walk into a drop-in Centre (like a shop) and get any service she needs. This model is also cost effective because it does not require heavy investment on both assets and equipment, it just needs human resources who are passionate about changing the narrative of our rural communities.

Out of the 67% of people living in rural areas of Kenya, 70%  of women, girls and children from hard to reach communities lack access to reproductive and primary healthcare. This contributes to the 1 million children who die before they are 5 years old in sub Saharan Africa every year,  500,000 maternal deaths in Kenya each year   because of lack of access to reproductive healthcare and poor infrastructures. The poorest inhabitants by income in Kenya live in rural areas, where poverty rates are higher (40%, compared to 28-29% in peri- or core-urban areas).

Our target population is women, girls and children because they are the most affected by lack of access to quality, proximate healthcare in rural areas. They are also most affected by climate change, culture and biases because of gender and discrimination.

Our solution will address their needs by giving them a basic need - Quality primary healthcare that is tailor made for them to include Reproductive health and maternal child health.

They will be able to access these services in their villages even if the villages are very far from link health facilities, they will then be able to plan their families and decide on the number of children they want to have. If they have children, then these children will not die from preventable diseases because they will get their routine immunization. The women will get time for work other than reproductive, they will improve the health outcomes of their children, get education for their children, vie for leadership opportunities and create communities of healthy, educated citizens.

Dandelion Africa is a female-led Kenyan NGO focused on women’s health and is rooted in a marginalized area and has knowledge of rural cultures and social norms as well as of the challenges facing the communities in the area, with special regards to women, youth and men.  We are currently implementing programs in Nakuru, Baringo Narok East and Kajiado County.  

When local organizations like us,  comprising of community members have the capacities, resources, and power we need to decide how to strengthen our resilience, we bring specific skills, knowledge, access, and the ability to understand and adapt to the local context. We have critical knowledge and experience of the challenges our communities face and their consequences, the actions that help to reduce risk, and the barriers to those actions.   

We live and work in these communities, most of our staff were born here. We engage deeply with the communities we represent; we understand these communities well and we are committed to developing sustainable solutions that work for our communities. We further identify and focus on the systemic forces at the root of the community problem, and we work to create solutions that show our vision for a better community. We are deeply embedded in our communities, and we are locally-led. This provides low-cost solutions without compromising on the dignity of our communities enabling us to reach more people.

Our Community challenges are complex and interlinked, economic growth affects society and the environment.  Integration facilitates longer-term results; when responses are integrated and engage cross-sectoral actors, their sustainability is more promising and are more frequently scaled up and expanded. Our integrated model of Women livelihood, Youth Empowerment, Advocacy and healthcare provides a holistic model that has been tried and tested and works to change communities in an all-rounded way and get them out of poverty.

We work with government offices and policy makers because we understand the importance of collaboration. By scaling up the Back Pack Drop in Clinics Model, more women and girls will have time to engage in all the other 3 strategies and get them out of poverty.

Solve can help me with connecting us to peer support, as a grass root organization, we need mentorship, we know that we are innovative, we need support with monitoring and evaluation and documenting our successes.

We also need connections with potential allies and partners who will grow with us to the next phase.

We are also looking for support in Social entrepreneurship  for sustainability and in crafting our model so that others like us, do not start from scratch but can learn from us.

We want to share with the world the impact of integrated models which is still new to some partners, share how it works and learn from those who have succeeded.

Lastly we want support in funding to scale up our work so that no one in our rural communities is left behind.

The situation in rural Kenya

Despite progress in health policy and service delivery infrastructure, Kenya’s maternal mortality ratio remains high (342 per 100,000 live births). There are wide disparities in maternal and neonatal health indicators across and within counties, with access to skilled attendance during childbirth ranging from 22 per cent in arid and semi-arid areas to 93 per cent in some urban counties. Nearly three in every four maternal deaths are linked to direct causes, such as postpartum hemorrhage, hypertensive disorders, infections, and other delivery-related complications. While most maternal deaths are preventable, only one-third of public health facilities can deliver the seven life-saving signal functions of basic emergency obstetric and newborn care. Key gaps include a lack of readiness and functionality of the health system, including inadequate skilled human resources for health, gaps in the quality of care, inequitable geographic distribution of services, high levels of unintended pregnancies, particularly among young women, and gaps in financing and affordability of healthcare.

The Innovation

The Backpack Nurse model has been operational for 3 years, Dandelion Africa has been conducting both sensitization and provision of SRH services door to door and through drop-in village centres where women and girls  have a space in the village just for their primary health, reproductive health and maternal and child health services in villages where facilities are far away and difficult to access due to poor infrastructure. Some of the  reproductive health services offered are;  antenatal, postnatal and newborn care; family planning,  preventing unsafe abortion through counselling and referral; testing and treatment of STIs, testing of HIV and management, reproductive tract infections, cervical cancer, menstrual health and health education. Dandelion Africa services are integrated to reduce cultural stigma because most men do not allow their wives and daughters to access contraceptives due to cultural beliefs.

In that period, to date, over 18,000 women of reproductive age have received contraceptives in rural area. The model is simple:  We use a hub and spook approach where any services that can not be handled at the drop-in centres including skilled deliveries, Comprehensive care of HIV, ANC Profiling and ultrasound, are all referred to a link facility like Dandelion Medical Centre or a government health facility closest to the drop in centre. Over 1500 safe skilled deliveries have been referred from the drop in centres to Dandelion Medical Centre and other facilities in the last three years.

Outcome: By 2027, 1 million women and girls in  rural Kenya at risk of being left behind, particularly women and girls, youth and children, all in the arid and semi-arid land counties  have improved, inclusive, and equitable social and protection services - especially quality healthcare.

Imagine every village having a drop-in centre - this is a very basic centre in villages, rented or given by communities, they have simple furniture, but the services offered there by the mobile nurses are of quality -

Imagine nurses on motorbikes leaving different facilities (it will not matter how far the facilities are from the community or how bad the roads) The nurses will reach the villages - they will arrive with back packs, full of everything from vaccines, contraceptives even a portable ultrasounds, HIV testing and ARTs, the Community Health Volunteers who live in these communities, give health education and mobilize communities to come to the drop in centres. When the nurses arrive, they offer quality services, and they can come back once a week or as per the agreement with the community.

This model is easily replecated, we currently have 44 drop in centres and one can see the impact of offering both contraceptives and maternal child health to women and girls

1. Contribute to Goal 3 - Good Health and Well Being

Ensure healthy lives and promote well-being for all at all ages- Indicators we will measure are:

1.  Maternal mortality ratio  in the counties
2.  Number of counties with at least 30% of primary public health facilities providing basic outreach (Back pack nurses services) to reach communities who can not access their facilities.

3. Number of women, adolescents and youth accessing life-saving sexual and reproductive health and gender-based violence services in the counties

4. Number of adolescents and youth, including those with disabilities, reached with information and services that promote their health and well-being

2. Contribute to Goal 1 - No Poverty

We want to empower and promote the social, economic and political inclusion of all,irrespective of age, sex, disability, race, ethnicity, origin, religionor economic or other status

Why? African countries are known for poverty, the narrative of our countries does not show the vibrancy and hard work of the women and girls but the poverty associated by climate change, poor governance among other things.

When women access quality health care - they get time for work. The indicators we will measure is:

1. Number of counties with the capacity to generate, analyze, disseminate and utilize disaggregated data on economic improvement, population, sexual and reproductive health, gender-based violence, harmful practices.

2.. Number of women accessing contraceptives who have businesses

3. Number of children able to go to school due to better health

4. Total improved income of communities who access Back Pack Nurse

4. Projects started by communities

Theory of Change

Key Strategies

• Access to health
• Economic livelihood
• Access to education
• Gender based violence prevention

Medium Term Outcomes

• Women & girls receive contraceptive
• Women start businesses
• Girls finish high school
• Reduction in female genital mutilation

Impact

EMPOWERED WOMEN, HEALTHY COMMUNITIES

We currently work with over 200 community health volunteers, this innovation has the breath to work with up to 2000 CHVs, our CHVs will work with Open Data Kit, an app that will collect data on both the needs of the community and will inform the county government on what health needs our communities need

Because internet connection is a challenge in our communities, we will set up bulk SMS information for women and girls on where to get services, when and in the event of GBV cases, where they can get help.

Our population is youthful and we will use our drop-in centres to train youth on basics of digital marketing, health and professional ethics.

Our leadership team comes from the communities we serve, we engage everyone regardless of their tribe, culture or culture.

Dandelion Africa has a community board of people from across sector i.e. primary and secondary students, persons with disability, persons living with HIV, young women and men, village elders.

We all come from the marginalized communities we serve,  we understand the deep rooted challenges of our communities and are best placed to come up with solutions together with our communities.

This business model is based on the current situation and the county we work in.

Problem Statement

Out of the 67% of people living in rural areas of Kenya, 70%  of women and children from hard to reach communities lack access to reproductive and primary healthcare. This contributes to the 1 million children who die before they are 5 years old in sub Saharan Africa every year,  500,000 maternal deaths in Kenya each year  because of lack of access to reproductive healthcare and poor infrastructures. The poorest inhabitants by income in Kenya live in rural areas, where poverty rates are higher (40%, compared to 28-29% in peri- or core-urban areas)

Solution Statement

Dandelion Africa provides an integrated model of healthcare and economic empowerment through the construction of a Medical center that provides reproductive and primary healthcare to women, youth and children from hard to reach rural communities. We provide free access to healthcare to women and children under the age of 5 and provide women  with access to affordable and quality reproductive health. We provide information on business skills, provide accessibility to capital and mentor women  and youth to become self reliant.

Value Proposition

For women and children who lack access to quality healthcare in rural areas, Dandelion Medical Centre provides an integrated health model, that provides reproductive and primary healthcare to women and children from hard to reach rural communities.

We provide quality, affordable and personalized follow up system through a unique model of extension  door to door  and drop - in centres - women-led backpack nurse to ensure SRHR antenatal and post natal care is offered at their door step, which is currently unavailable in the County.

Unlike public medical centres, Dandelion provides free healthcare to children under the age of 5, so that marginalized women in rural areas can afford  healthcare for themselves.

Intervention

1.  Free Healthcare to children under the age of 5 years
2. Quality, affordable and accessible reproductive health services for women.
3. Extension door to door  and drop -in centres with the backpack nurse to ensure antenatal and post natal care is offered at their point of need
4. Economic empowerment for women and youth

Impact Metrics

1. 240,000 lives improved
2. 10,000  children avoid infant mortality 
3. 3,570 women have increased household income
4. Over 30,000 women and girls have received contraceptives 

Target Addressable Market

Dandelion Africa is a Cross Border organization

Quantitative Variable - Baringo, has a population of 666,763

Psychological Variable

1. High poverty levels
2. Long distances to health facilities
3. Lack of knowledge of SRH and poor health seeking behavior

Market Demand For Services

Compelling Reason for Adaptation

1. Focus on Self Sustainability of communities
2. Affordable and accessible healthcare with Backpack Nurse model taking healthcare at their door step
3. Youth engagement focusing on future of communities

Assumption

1. Improved Health Seeking behavior due to accessibility of 50% of the population
2. Communities economic growth due to women accessing SRH and capital for business
3. Educated community due to access to opportunities for education
4. Reduction of Poverty

To become financially sustainable is difficult for a non-profit, however we are working toward being 50% sustainable by 2027.

We will continue to look for donations and grants, raise investment capital to build more clinics and sell products and services to both public and private sector.

We are Kenya owned, women led, 10 year old, grass root non-governmental organization with a Net Book Value of USD . 559,937. This is important for us because we have constructed a public library, office spaces and we do climate change projects that communities can learn from, we have over 800,000 tree seedlings within the women groups that we jointly sell to the communities to support environmental conservation in our arid areas.

We have invested in being sustainable by constructing a Level 3 medical centre in a rural village that is currently No. 2 in providing health services in the Rongai Subcounty of Nakuru county over (500 skilled deliveries in 2021).

We drilled a borehole (300meters) to sell water to communities around our facility a population of 23,000 people because the nearest clean water source is 10kms away.

The women we work with in our integrated model keep bees and produce honey, they sell to us and we supply to other institution at a small margin to promote both the communities and the organization.

We have recently started a new project in consultation where we are packaging our Integrated model that supports, health, education, economy and advocacy and teaching others.