![WASH](/sites/default/files/styles/medium_landscape_16x9/public/2021-04/Baby%20Damian%20from%20Mwala%2C%20ADP%20Kenya%2C%20is%20given%20water%20from%20a%20water%20project%20WV%20implemented%20in%20the%20area._0.jpg?itok=UPNwU2qX)
Integrated Health & Water, Sanitation and Hygiene (WASH)
Objective: Improved survival and protection of children under five years, as well as protecting adolescents and mothers from infections and diseases in Kenya by 2025
Outcomes:
- Improved access to responsive health services for adolescents
- Improved health care for mothers and children below 5 years old
- Reduced prevalence of WASH & environmental related diseases
Models/Approaches
We use the following approaches to implement Integrated Health and WASH projects:
A. Focus Areas (Health)
1. Child Health
Our key priority is reducing child mortality by improving the health status of children and their families in marginalised and fragile contexts. This is because we recognise that investing in children’s health is the foundation for a healthy generation, which will bring immense returns to the society. To achieve this goal, we work with Kenya’s Ministry of Health and like-minded partners to address health challenges affecting children below five years (0-59 months). We give special attention to the first 1000 days of a child (from conception to two years of age) as this period is critical to their survival. The following legal frameworks guide our work:
- Kenya Constitution (2010)
- Kenyan Health Policy (2014-2030)
- Kenya, Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) investment framework (2016)
- Newborn, Child and Adolescent Health (NCAH) Policy (2018)
Following the World Health Organisation (WHO) and UNICEF Integrated Management of Childhood Illness approach, World Vision Kenya focuses on:
- Strengthening of health systems and improving community access to quality services, especially in counties with a high mortality burden, vulnerable communities and various forms of emergencies
- Achieving full vaccination for children below one year old (12-23 months)
- Preventing common childhood illnesses such as pneumonia, diarrhoea and malaria which are the main killers of children under the age of five
- Promoting early detection, referral and treatment for children below five years
- Improving community based health structures and behaviour change processes through Kenya’s Community Health Strategy
- Enhancing availability of essential health commodities, supplies and equipment
- Enhancing households access and utilisation of safe water, improved sanitation and hygiene practices
2. Nutrition
World Vision works with the Government of Kenya and other partners to address nutrition gaps in vulnerable communities. We seek to ensure that all children enjoy a good nutrition status, which is key to their development and wholesome growth. Our interventions are aligned to the Kenya Health Policy, as well as the National Food and Nutrition Security Policy. Our work focuses on:
- Maternal infant and young child Nutrition
- Food Security
- Nutrition in Agriculture and Livestock
- Nutrition in Education and Child Protection
- Micro nutrient Deficiency Control
- Nutrition in Emergencies
- Nutrition Capacity Development and Learning
3. Mental Health
To tackle common mental health conditions affecting Kenyans, we are implementing a new World Health Organisation (WHO) low-cost model known as Problem Management Plus (PM+). Unlike conventional approaches that rely on professionals, this new model is being implemented by Community Health Volunteers (CHVs) who help affected people to self manage common mental health problems such as depression, anxiety, stress or grief. They do this by training them on basic strategies of dealing with stress, solving life problems and adopting behaviours that guard against mental health challenges. Kenya faces a high mental health burden yet there is an acute shortage of professional mental health specialists - such as psychologists and psychiatrists - in the country. The trained CHVs are bridging this gap, hence enhancing access to mental health services to Kenyans in different areas, including communities in remote and rural regions. These efforts are contributing to the universal access of mental health services as per the Kenya Mental Health Policy (2015-2030).
4. Maternal Health
In Kenya, many women die each year during pregnancy and childbirth. World Vision partners with the government and other stakeholders to avert this challenge through initiatives that are in line with the National Maternal and Neonatal Health Road Map, which focuses on:
- Antenatal Care during pregnancy
- Enhancing skilled care during childbirth
- Post natal care and support in the weeks following childbirth
- Health Timing and Spacing of Pregnancies
- Supporting the roll out of the Community Health Strategy
5. Adolescent Reproductive Health
Adolescents constitute a large proportion of Kenya's population. This has implications on the country's health and development agenda. World Vision believes sexual and reproductive health care for adolescents is essential for young people to realise their full potential. To realise this goal, we focus on:
- Strengthening health services to offer young people the sexual and reproductive health care they need without judgment or bias
- Empowering adolescents and youth to make their own decisions about their bodies and their futures by changing community norms related to gender, adolescent sexuality, early marriage, and childbearing
- Supporting young women and first-time parents to delay their first pregnancy and space their births for the best health outcomes for mothers and children
6. Malaria
As part of addressing the gravity of malaria in Kenya, World Vision has invested in improving prevention and management of the disease. This effort is in line with the National Malaria strategy's (2019-2023) goal of reducing Malaria Incidence and deaths by 75 percent (by 2023), towards a Malaria free-Kenya. The focus is on:
- Vector control( Long Lasting Insecticide Treated Nets, Indoor Residual Spraying, Larval Source Management)
- Malaria diagnosis and treatment
- Prevention of malaria in pregnancy
- Monitoring and evaluation
- Operation research
World Vision Kenya continues to contribute to the progress made in Malaria control through multifaceted approaches key being control and prevention.
7. Tuberculosis (TB)
Our TB interventions are aligned to Kenya’s National Strategic Plan for Tuberculosis, Leprosy and Lung Health (2019-2023). It guides TB prevention, diagnosis and treatment approaches at the County and National level. We deal with the following:
- TB care and prevention
- Multi-Drug Resistance-TB
- TB/HIV Integration
8. HIV & AIDS
Based on the Kenya AIDS strategic Framework (2014-2019), our fight against the disease focuses on the following:
- Community-based HIV prevention
- HIV awareness
- HIV Stigma reduction
- Capacity building of local health workers on Prevention of Mother To Child Transmission (PMTCT), Elimination of Mother to Child Transmission (eMTCT) of HIV and Anti-Retroviral Therapy (ART) education and adherence.
B. Focus Areas (WASH)
1. WASH Governance and Financing
We work with the National Government and County Governments, and with community health volunteers at local levels to support community mobilization to raise awareness and promote uptake of good WASH services and practices. We also partner with the Ministry of Water and Sanitation to train water management committees on water governance.
We collaborate with governmental and non-governmental stakeholders to influence government plans and budgeting processes. This way, we ensure resources are well-distributed in areas of need. Through supporting the formation of Citizen Voice and Action (CVA) groups, communities advocate to county governments for improved service delivery at all levels.
Our WASH program uses a community-based participatory approach and Public Private Partnerships (PPPs) to support sustainability. The main objective is to address the inherent operational, maintenance and management challenges WASH projects have experienced due to a lack of long-term sustainability and accountability.
2. Sanitation and Hygiene Behaviours
The Community-Led Total Sanitation (CLTS) approach is a key behaviour change approach we have adopted. The approach enables community members to improve their communities through actions such as advocating for latrine construction and has proven successful in Kenya. Other approaches we have successfully used as part of our behavior change strategy, include faith engagement, peer-to-peer education, and BabyWASH.
The integration of faith and WASH is gaining momentum. When faith leaders are trained on improved sanitation and hygiene, they can then disseminate WASH messages to their congregations.
We also focus on inclusion to ensure that water projects consider the needs and security of vulnerable groups such as children, the elderly, women and people with disabilities (PWD). In order to have equal access to the WASH interventions, these groups need special accommodations, which include program location, accessibility, reliability and affordability. Representation from these vulnerable groups is also required in the WASH management committees.
Menstrual Hygiene Management (MHM) in schools has also been a focal point for WASH programming. We have equipped some schools with MHM facilities. These MHM facilities are comprised of a small private washroom next to the toilet stalls where girls can manage their menstruation with dignity.
Our current WASH projects includes water user association members being involved in Village Savings and Loan (VSL) groups. The water user and sanitation groups utilize the water kiosks as a business opportunity by collecting fees from facility users, which are then used to fund operations, maintenance, and overall water management. This method keeps the committee united and reduces the risk of water revenue mismanagement.
Other initiatives include establishing income generating activities like livestock management and small-scale irrigation, where available water can support VSL groups. We have also trained artisans to make concrete latrine slabs, pit lining, and superstructures, which supports local entrepreneurship and increases latrine affordability for households working to improve their sanitation.
World Vision promotes hygiene in schools by establishing school WASH clubs and training students to lead peer-to-peer educational activities (e.g. hygiene and sanitation campaigns). School WASH clubs play an essential role in sustaining school water points, latrines, and hand-washing facilities. Children who participate in WASH clubs are usually eager learners, leaders, and effective change agents within their schools, families, and communities.
3. Access to Safe Drinking Water
World Vision has made significant strides in promoting sustainable access to safe drinking water in Kenya. We have formed and strengthened water user committees, who manage water projects even after the project ends. We have also ensured access to safe water through technologies such as boreholes, pipeline extensions, spring protection, shallow wells and rainwater harvesting systems.
Access to water during emergencies is critical. Several of our projects have focused on providing safe water for vulnerable communities in fragile contexts. The provision of these projects includes boreholes, pipelines, spring protections, rain water harvesting infrastructures, water pans and rock catchments, primarily in Arid and Semi-Arid areas.
We also work to mitigate the effects of flooding and droughts by lining latrines with trapezoidal blocks to manage collapsing, and by constructing water harvesting systems for water conservation efforts. In areas prone to drought, boreholes with solar powered systems are constructed to incorporate multiple use water to provide water for livestock and small-scale irrigation.
4. Management of Water Resources
World Vision Kenya has contributed to the water policies and regulations for several County Governments in areas of operation such as Wajir and Makueni Counties.
Also, upon discovering mismanagement of financial resources by water committees, we have adapted an innovative and transparent approach for collecting water revenue. The use of AQtaps (an automated water dispenser) for piped-water systems was determined to be the best option to improve water sector governance and management, reduce operation costs, and increase water service delivery. By using a key card, community members can transfer funds to their account through a mobile money platform, which tracks transactions and secures the funds.
A key focus area for World Vision Kenya is advocating against water source contamination, which includes enhancing sound hygienic practices for safe water handling from source to point-of-use at the household level. Communities build capacity around the 3R principles of reduce, reuse and recycle to enhance efficient water use. For example, in urban areas that have high amounts of water waste, households that use pour flush toilets are encouraged to use water from washing clothes for flushing the toilet, and to use waste water from the kitchen to water the garden.