Ontwikkelingswerk Theo Kiewiet

Project Brief:

In 2004, eight children died every month in the villages of the Shibinga region in Kenya. Malaria was a matter of course for the local population. Mothers were at the end of their wits: child after child had to be buried, while they too, suffered terribly from the disease. Following a collection on Christmas Eve 2004 by the island parish of Ameland, Bulechia was the first village to receive insecticide-treated mosquito nets. This was the first effective step in stopping malaria. The results were immediate: children stopped dying and the number of (seriously) ill villagers declined dramatically. All of the poor families in the neighbouring villages that were still facing the horror of malaria noticed the positive results in Bulechia.

Another collection for Kenya soon followed on Ameland, enabling one village in Shibinga after the other to receive the same effective help. The people of Ameland helped rid 16 villages and their ±15,000 inhabitants of malaria. The Pioneer Group Bulechia is applying the same successful methodology in the villages in the region of Shibinga. In addition to providing preventive and curative treatment by handing out mosquito nets and drugs, future intervention will include micro-credits for the next generation of mosquito nets and aid to destroy the malaria mosquito's breeding grounds. Malaria No More!'s planned intervention will help free another 70,000 or more inhabitants of the Shibinga region of the deadly and devastating Malaria Tropica disease.

Goal

To effectively and permanently eradicate malaria in the Shibinga region of West Kenya and thus reduce childhood death by 100% and cases of the disease by more than 95%.

Activities

• Distribute insecticide-treated mosquito nets to all (pregnant) wome n and children under the age of five.
• Educate all of the village elders and all of the women in the region about malaria and the use and maintenance of mosquito nets.
• Grant a micro-credit to women's groups so they can buy new insecticide-treat ed mosquito nets after five years.
• Train the project coordinators so they can effectively eradicate malaria in the region in the long term.
• Provide malaria drugs to people who really have malaria.
• Use neem tree oil to destroy the malaria mosquito's breeding grounds.

Project Report:

The first sublocations that the pioneer group focused on in 2009 were Malaha and Khaunga.

The following activities were carried out between January and December 2009:

Assessment: With the help of the villages' women, the pioneer group assessed the composition of each village's population. They determined that a household had an average of three children under the age of five and, because each man has two wives, that every family had an average of six children under the age of five.

Education: Before distributing the mosquito nets, a project leader organized meetings in every village where all of the inhabitants were educated on malaria and the use and maintenance of mosquito nets. The subsequent assessment ensured that each household received the right number of mosquito nets. The following topics were discussed:

• What malaria is
• How people get malaria
• The symptoms
• The drugs that are available and their efficacy
• Why prevention is better than treatment
• Why living in a clean environment is important
• Why a clean community is important

Distribution of mosquito nets: Although the Kenyan government instructs that mosquito nets only be given to pregnant women and children under the age of five who visit a health clinic, the Pioneer Group decided to visit all of the households and hand out mosquito nets because a lot of people don't go to a health clinic but consult a traditional medicine man instead. A total of 10,639 insecticide-treated mosquito nets were procured and distributed in 10 villages in Malaha and in 1 village in Khaunga.

Breeding grounds: The Pioneer Group also tackled the mosquito's breeding grounds with neem cake, an organic product from a local tree that is made from neem seed. The results for 8 of the 10 breeding grounds that were treated with neem cake were very positive.

Diagnostic tests: Three months after distributing the mosquito nets, the Pioneer Group organized a week of malaria diagnosis days in the health centres of Khaunga and Malaha. Trained people used two diagnosis methods:

• Rapid Diagnosis Test (RDT)
• Blood is examined under the microscope

Of the 500 people tested in each sublocation, only 36 people, or 7.2%, tested positive. The reports from the Ministry of Public Health, which are based on data provided by the Pioneer Group, showed a reduced occurrence of malaria. People who were diagnosed with malaria were prescribed drugs. The monitoring and evaluation team found out that some people who had contracted malaria had stopped using their mosquito nets because they thought the malaria season was over.

Micro-credit: In the Mung’ang’a sublocation, 1,567 ‘second generation’ mosquito nets were distributed as part of the micro-credit system. So far, none of the households have had to use the Shs. 250 micro-credit that had been set up for them to buy new mosquito nets because the scheme was implemented after they had received their first mosquito net.

Training the project coordinators: A two-year Community Development and Social Work training is currently underway and will be completed in September 2011. This training will enable the project leaders to ensure that project activities run effectively. The group members will also attend courses that will help them solve problems that can occur in a rural community and that are aimed at a participatory approach.

The results of these activities are positive

Fewer deaths: The government office that issues death certificates reported that the number of deaths had decreased by 95 to 98%.

Fewer cases of the disease: The local health centres reported that the number of people infected with malaria had decreased by 90 to 95% in the villages where the pioneer group educated the people and handed out mosquito nets.

These positive results can be ascribed to the participatory approach: representatives of the Pioneer Group, members, village elders, the provincial administration and people in the community made this project a great success. By participating, the project beneficiaries also become the owners of the project and are able to take responsibility.

Challenges during the project period:

• Getting people to collaborate was not always easy. Village elders were reluctant to collaborate: they wanted to be paid. It took a while for them and the families to realize that it was in their best interest to cooperate.
• Some politicians used the project to bind voters, which led to many families turning down the mosquito nets. The Pioneer Group invited all of the local leaders to distance themselves from politics during the distribution of the mosquito nets and convince the local population that the project had nothing to do with politics.
• Rectangular nets proved difficult to hand out. Because people associated the shape of the net with graves, we bought and distributed round mosquito nets instead.
• The proposal did not include people who were older than 5 and people who were single: these people were not given a mosquito net. They are not part of the Kenyan government's target group. The Pioneer Group will address the issue with the Kenyan government and request that they include these people in their follow-up plans, because they too, can contract malaria.
• Patients with a second condition, such as anaemia, asked for help but didn't receive any. The Pioneer Group asked the Kenyan Ministry of Health to allocate more money to the treatment of other (malaria-related) diseases.
• Some families are so poor that they don't have enough to eat. As a result, they sold the mosquito net they were given in exchange for food. That's why an agreement was made that penalizes the reselling of mosquito nets. A weekly (social) control was carried out to make sure no mosquito nets were being sold.
• An increase in prices between the time the quotation was made and the time the nets were delivered also created problems. The Pioneer Group is looking for reliable suppliers with whom they can enter into a watertight contract and prevent such problems occurring in the future.
• The capacity of the lab is limited. This means that a drug is prescribed based on the clinical symptoms the patient presents with. As a result, people can be prescribed the wrong drugs.

Expected challenges for the coming period (2010 and 2011):

• The population will grow. There are a lot of weddings and thus a lot of babies. A logical consequence is a bigger target group. The composition of the population will be analyzed before the mosquito nets are purchased and distributed.
• To prevent price fluctuations, we found a reliable supplier who will deliver the insecticide-treated mosquito nets at a fixed price.
• Agreements were also made with this supplier on the delivery of the mosquito nets to make sure they arrived according to schedule.
• Because the project area is slowly expanding, transport is an ever increasing challenge. Bicycles can be used for distances up to 20 km, but anything beyond that requires the use of motorbikes and pick-ups that have to be hired, which impacts the planning and the costs. In the future, participants in and beneficiaries of the project will be asked to transport the mosquito nets to their destination from a central point.
• The Pioneer Group initially focused on the East Wanga division whereby the Shibinga location had 8 sublocations. The number of villages, sublocations and locations had grown by the end of the first project year. To ensure quality, new locations are not added to the project scope.

Lessons learned

• The Pioneer Group's way of running the project with shared responsibility is the only way to achieve the goal. The malaria project gives local communities a voice and enables them to make their need for help heard as far up as the provincial government. This pressure makes the government realize that it has to take better care of the poor. Because the government does not have enough employees, the Pioneer Group is accepted as an extension.
• The project was a huge success thanks to the fantastic collaboration between the Pioneer Group, the local government, the village elders and the communities. The social cohesion within the communities has improved because malaria - as devastating as it is - unites them. Youths become active and help scale-up and accelerate activities. They are even called 'malaria fighters'.
• The Pioneer Group learned that despite the (future) developments in health care, a large part of the population still relies on traditional healers. By involving and collaborating with traditional medicine men and women in the fight against malaria, that part of the population that the Pioneer Group cannot reach still receives the information it needs.