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Train Traditional Birth Attendants, Don’t Ban Them

Traditional birth attendants (TBAs) remain the main providers of delivery services, especially in rural and remote areas. Rather than banning them, governments should support them to reduce maternal and child mortality, and ensure that they get adequate training.

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Throughout African history, traditional birth attendants (TBAs) have provided maternity care for women despite having no formal training.

Poverty, cultural practices, and a shortage of primary healthcare services are forcing women to seek the help of untrained traditional birth attendants, despite the serious risks involved.

Last year Kenya recorded a maternal death rate of about 362 per 100,000 live births and an under-five death rate of 52 per 1,000 live births, while in Tanzania, one in every 126 women die due to maternity complications. The story is the same in Uganda and Ghana as well. According to the World Health Organisation (WHO)’s figures for 2016 on maternal mortality, 560 women die per 100,000 births in Nigeria.

Despite these shocking figures, women, even learned ones, are still flocking to unskilled birth attendants’ homes to give birth, putting their lives at risk. Why is this so? Is it is because governments are failing them?

For some women, traditions prevent them from attending hospital. For others, long distances to medical facilities prevent them from reaching a health facility in time to give birth. Some are put off by health workers’ attitudes.

TBAs can provide them with all the care they need, both during and after pregnancy and childbirth, and there is no doubt they are a much-needed resource.

In 2013, the Kenyan government introduced free maternal healthcare. The goal was to encourage more women to give birth in health facilities. However, according to data from the Kenya National Bureau of Statistics (KNBS) released this year, more women are still flocking to TBAs.

It is evident that pregnant women are not satisfied with the quality of care they are given at the hospitals. With the high number of women taking advantage of the free services, combined with the few health care workers to attend to them, some women are giving birth on their own even when they are in hospitals.

In 2013, Kenya had one of the highest maternal mortality rates in the world: 488 maternal deaths per 100,000 live births, according to the Ministry of Health.

In 2013, the Kenyan government introduced free maternal healthcare. The goal was to encourage more women to give birth in health facilities. However, according to data from the Kenya National Bureau of Statistics (KNBS) released this year, more women are still flocking to TBAs.

According to KNBS data for 2015/2016, the findings reveal that three out of ten children were delivered at home in 2018 in Kenya; this is an estimated 31.3 per cent improvement from 53.9 per cent recorded in 2005/06.

The survey showed that in rural areas the proportion of children born at home was 40.7 per cent compared to 13.3 per cent in urban areas.

Childbirth statistics in Kenya
“The county with the lowest proportion of children born at home was Kirinyaga, at 3.8 per cent, while Wajir, Mandera, Samburu and Marsabit had over 70 per cent of children born at home. Kirinyaga, Nyeri and Kisii counties recorded over 90 per cent of children born in a health facility,” KNBS stated.

The proportion of children delivered with the assistance of a traditional birth attendant in rural areas was 25.6 per cent compared to 7.8 per cent in urban areas. Wajir, Mandera and Samburu had over 60 per cent of the births assisted by a traditional birth attendant. Turkana County had the highest proportion of self-assisted births, at 34.5 per cent.

The low hospital births among pastoral communities may be partly linked to inadequate health facilities and personnel in the regions they live in. Families in pastoral counties also tend to be polygamous, which puts a strain on resources such as healthcare.

Nairobi, Kisii, Kiambu, Kirinyaga and Nyeri counties top in childbirths in hospitals, an indication of the success of the safety campaigns. These five counties are the only counties that recorded over 74 per cent of children born in hospitals.

Statistics further show that more deliveries are now handled by trained medical personnel, which is a plus in attaining safer childbirths. However, women in rural areas still prefer to be attended by TBAs, friends, and relatives during delivery.

According to WHO, with the exception of sub-Saharan Africa, where most births in rural areas are conducted by TBAs, rates of births assisted by a medically trained attendant have shown impressive increases over the past 15 to 20 years, Current data indicate that 59 per cent of births in the developing world are assisted by a medically trained professional.

Nairobi, Kisii, Kiambu, Kirinyaga and Nyeri counties top in childbirths in hospitals, an indication of the success of the safety campaigns. These five counties are the only counties that recorded over 74 per cent of children born in hospitals.

Uganda banned TBAs) in 2010 but they have continued to practise. Eighty per cent of rural women prefer TBAs to skilled attendants, according to officials at the Ministry of Health; 10 per cent of them delivered with the assistance of TBAs.

With TBAs playing such an important role in maternal and newborn healthcare, especially in rural areas, should governments abolish them completely or look for ways of incorporating them into the system as referral agents to hospitals?

One midwife’s experience

The Telegraph, through an informal survey in Kisumu’s Nyalenda Estate in Kenya, established that some mothers delivering in hospitals still relied on traditional birth companions during pregnancy and after giving birth.

Pictures of newborn babies adorn the walls of Margret Owino’s house. They are a treasured decor in the improvised maternity ward in her two-roomed corrugated iron-walled house. Hundreds of women have trekked the dusty and curvy road to Ms Owino’s Kisumu home, judging from the many pictures.

It is at 6 am when we got to her house. Dressed in a blue nylon apron, she is busy attending to a pregnant woman. In a busy month, she delivers over 60 children, according to her well-kept records.

Her small house acts as a labour and delivery room. She is among traditional midwives who assist women at childbirth, mostly in areas that lack infrastructure and trained health personnel.

Even though there are several health facilities in the area, some pregnant women prefer traditional birth attendants. They say they are more comfortable with them than obstetricians and trained midwives.

Ms Owino learned the midwife’s skills at a tender age. When she was 15 her late grandmother, who was a midwife, placed herbs in her right hand and some coins in the left — the traditional way of transferring the skills to her. This has since been her job. She is among Kenya’s 35 registered traditional birth attendants who work with hospitals to ensure safe deliveries.

She has had women who are bleeding profusely brought to her in the middle of the night. She does not attend to them but sends them immediately to the nearby hospital. Some clinics contact her to attend to mothers with breech births and at times they are brought to her “clinic”.

She also refers HIV-positive women to the hospital, but says she knows not all women disclose their status to her. She says it is a constant risk.

Her maternity services are similar to those in health facilities. She records clients’ details in a book and weighs infants on a weighing machine given to her as a token.

One of her clients said that harassment in public hospitals is one of the reasons they still troop to traditional birth attendants’ clinics.

Even though there are several health facilities in the area, some pregnant women prefer traditional birth attendants. They say they are more comfortable with them than obstetricians and trained midwives.

‘‘The midwives harass us, calling us names while we are often left in the hands of inexperienced trainees. The midwife can detect when a woman has the strength to push the baby or not, or if the baby is in the right position,” she says.

She says community midwives pamper and take care of women during and after delivery. She says this helps them give birth with dignity. That is why a lot of women come back to her when they are having another baby

Initially, the government was threatening the TBAs while others were being harassed and their tools were being confiscated. However, this has since changed; they are now being registered and undergo training to ensure safe deliveries.

The Ugandan government has also lifted the ban on TBAs and the focus now is training them. As a result, there has been a shift towards skilled birth attendants capable of averting and managing childbirth complications.

Ms Owino only attends to women who know their HIV status. She ensures that HIV positive clients have antiretroviral (ARVs) drugs given by a doctor, which she gives to the child immediately after tying the umbilical cord.

Benefits of supporting and training TBAs

Rather than educate against the use of TBAs, the United Nations Population Fund (UNFPA) believes that working with them is the best solution. It did a a study on the benefits of supporting and training TBAs across the world. The study was done in the Upper East Region in Ghana, and tracked antenatal visits and deliveries conducted by trained TBAs from 1990 to 1993.

“Antenatal visits increased from 20,000 to 180,000. Deliveries reported by TBAs increased from less than 10,000 to 50,000. Nationally, the percentage of TBA deliveries as a percentage of supervised deliveries increased from 16.4 percent to 22.2 percent between 1992 and 1993. Policymakers and program managers state that TBAs have contributed to: improve prenatal care, increase contraceptive acceptance rate, and decrease neonatal tetanus admissions”.

“The role of traditional birth attendants in the provision of healthcare in resource-poor countries is still important because of the current inadequacy of human resources for health. In developing countries for years to come, TBAs will remain the main providers of child deliveries in rural areas,” it states.

Dr Elizabeth Ogaja, a health analyst, says that midwives are an integral part of the healthcare system, adding that the reduction of maternal and newborn mortality in developing countries requires rigorous efforts that involve governments and non-governmental organisations in identifying TBAs who are known by the community to be experts.

“Recruitment and training of TBAs using adult learning techniques is important. The programmes should focus on basic primary healthcare, especially on symptoms of risky cases that need to be referred to formal health services and on hygiene to prevent mother and child from infections,” she says.

“Creation of dialogue, trustworthiness, patient, tolerance, willingness to collaborate, transparent and familiarity during training are key when working with TBAs as partners in health care and when sharing experiences,” says Dr Ogaja.

Training, she says, should be followed up by frequent meetings to share feedback and problems TBAs experience.

“We have realised that they are very important. Mothers trust them and we want to integrate them as much as we can. We advise that they bring pregnant mothers to hospitals so that we can take it from there,” she says.

Dr Lawrence Koteng’, the Homa Bay health executive, acknowledges the role played by traditional midwives but encourages expectant women to deliver in health facilities.

He says the county health department is training community health workers to discourage unsafe home deliveries.

“We do not support expectant women to deliver at home or anywhere except at health facilities where there are experts who can help whenever there is a complication,” says Dr Koteng’.

However, Allan Mayi, the deputy project director at Elizabeth Glaser Paediatric Aids Foundation, says the birth attendants should not attend to expectant mothers because they lack the skills needed to offer safe deliveries.

The organisation encourages women to deliver in hospitals and even offers incentives to birth attendants to take them to health facilities.

“Most mother-to-child HIV transmissions are recorded at midwives’ homes,” says Mr Mayi.

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Data Stories

Will 10 Million Kenyans Get At Least One Dose of a COVID-19 Vaccine by Christmas Day?

Based on the MOH daily cumulative number of vaccines administered, Kenya is on course to have 10 million vaccines administered by Christmas, based on the predictive AutoRegressive Integrated Moving Average (ARIMA( 5,2,1)) model.

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Will 10 Million Kenyans Get At Least One Dose of a COVID-19 Vaccine by Christmas Day?
Photo: Mika Baumeister on Unsplash
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During his eighth and last State of the Nation address on 30 November 2021, Uhuru Kenyatta reminded the nation of his pledge to have at least 10 million Kenyans vaccinated by Christmas. With just 25 days to go, the president urged Kenyans to get vaccinated to meet and surpass that target.

On the day of the president’s address, just 7,175,590 doses of the 13,909,670 received in the country had been administered.

The pressure to vaccinate Kenyans has been increasing. Data shared by the Ministry of Health in late November indicated that less than 10 per cent  of the targeted population was fully vaccinated and about 15 per cent had received at least one of the  COVID-19 vaccine doses.

Just nine days before the president encouraged Kenyans to get their COVID jabs, Cabinet Secretary for Health,  Mutahi Kagwe announced some tough measures. He said that Kenyans will be required to show proof of vaccination when boarding domestic flights, trains and buses, and while travelling from one region to another.

“Everybody seeking in-person government services should be fully vaccinated and proof of vaccination availed by December 21st 2021,” he said. “Such service will include but not limited to KRA services, education, immigration services, hospital and prison visitation, NTSA and Port services among others.”

The announcement sparked much debate among the public. Human rights defenders argued that the measures violated freedom of choice and threatened to deny basic services to citizens. Some taxpayers even joked about not paying their taxes since if they were unvaccinated, they would not be receiving government services.

Business owners, especially in the tourism sector, criticised the potential negative impact of these pronouncements on their businesses which experience a boom during the Christmas holidays.

But in the week following this announcement, the number of doses administered daily increased to over 100,000, except on the Saturday and Sunday. This is a significant rise. If we take data beginning on 28 September 2021, when MOH began to consistently upload the status reports, the average number of vaccines administered on a daily basis since that date was 52,796.

Vaccine roll out

The vaccination process has been highly dependent on the availability of vaccines, with more than half being  donations from higher-income countries like the US, UK, Denmark, Poland, France, etc.

Where the dates have been disclosed, the duration to expiry of the donated batches was between 25 and 136 days. While the Johnson & Johnson  batch that the government of Kenya had received on 3 September 2021, just before it last reported the expiry date of various vaccine batches, had 635 days to expiry.

It is not reported whether there were any vaccines that were discarded because they had expired.

Kenya had received 13,909,670 vaccines by 30 November 2021. The challenge is to match uptake with the now increased availability of vaccines. More than half of these vaccines are yet to be administered.

So, how likely is it that the government will have every adult Kenyan vaccinated by 21 December 2021 to avoid the consequences announced by CS Kagwe? Or is President Kenyatta’s Christmas pledge more realistic?

Predictions

Based on the MOH daily cumulative number of vaccines administered, Kenya is on course to have 10 million vaccines administered by Christmas, based on the predictive AutoRegressive Integrated Moving Average (ARIMA) model.

But this forecast will become reality if more Kenyans are persuaded to take the time to visit their nearest medical facility which according to the President is now stocked with the vaccine doses.

More realistically, about 9 million doses could be administered by Christmas if all factors remain constant.

The cumulative number of vaccines administered is non-stationary, meaning that it has a time-dependent structure and does not have constant variance over time. This can be  attributed to pattern changes based on the availability of COVID-19 vaccine doses in the country and also due to various efforts undertaken by the ministry at different times.

It is clear, however, that the uptake of the doses has now become steady. But the uptake is not increasing at the same rate as the vaccines are becoming available. This could be because of ineffective communication to the public. Also, there may be vaccination apathy following the long waits for sufficient vaccines, the long queues once they become available and visits to medical facilities only to find no vaccine. I made one such visit which was disappointing.

Worthy of note is that in August the government issued its first vaccine mandate to all public servants who were compelled to get COVID jabs or face disciplinary action.

Now, over 95 per cent of health workers and teachers are fully vaccinated. The new mandate widened the scope to the general population, including millions of jobless Kenyans, and seems to be bearing fruit already.

Data management challenges

The prediction above is based on the kind of data the ministry of health has released. The MOH Twitter page and website have been the main avenues through which vaccination progress has been communicated.

Looking at the vaccination data, one gets a sense of how the data aspect of this pandemic has been a case of “building a plane while you fly it”. This can be seen in the way data is released for public use.

Data is first shared in the form of images on twitter and PDF documents are then uploaded on the MOH website.

Let us drill down to illustrate some problems by focusing on 14 July 2021.

  • The vaccines that had been administered on this day were 1,565,344.
  • The same status report indicates that 31 first dose and 1034 second dose were administered on that same day.
  • Total vaccinations on 15 July 2021 were 1,590,765. It is not clear why the difference between the two days is 25,421, since the doses reported to have been administered on the 15th are 263 for the first dose and 6730 for the second dose.
  • The discrepancy is not comprehensible and it is the case for many other days until much later, in November, when the numbers start to add up.

Additionally, the number of total daily vaccinations in the status reports uploaded on the MOH website differs with what is in the Humanitarian Data Exchange (HDX), HUMDATA, an open platform for sharing data across organisations which relies on figures that are verifiable based on official public sources including Our World in Data (OWID) who in turn extract data from the updates from the MOH twitter timeline as well as on the website.

Another major issue for anyone seeking to explore Kenya’s vaccination data is missing data.

Dataset such as HUMDATA and OWID had data scraped from the MOH twitter updates initially.   We had to  combine data from the HUMDATA dataset and MOH status reports together to reduce the amount of missing data. However some figures recorded by Humdata were a day ahead compared to the figures in the available status reports presented on the MOH website.

The level of readiness in terms of how to capture and manage  the data is questionable. The status reports shared had not captured or anticipated the assortment and diversity of the vaccines Kenya would receive over time. Several elements (variables) are introduced at different times. This makes any automated technique of extracting the data extremely difficult and time-consuming. For example, up until 1 July, the reports had “Cumulative persons vaccinated to date”. But this was changed  to “Total vaccinations” to cater for those who were receiving their second doses of the AstraZeneca vaccination which began on 28 May 2021. Later it emerged that just a single dose of Johnson & Johnson would amount to full vaccination status so official data was changed from Dose 1 and Dose 2 to partially and fully vaccinated persons.

Gender was another variable that evolved with time. Initially genders were badged male, female and “other”. This was later changed to “intersex”, and “transgender” was subsequently added.

These discrepancies, in addition to the data provided in PDF forms, make it extremely difficult and time consuming for experts to explore the data and for the public to monitor the accountability and transparency of the vaccine uptake.

This OUTBREAK story was supported by Code for Africa’s WanaData program as part of the Data4COVID19 Africa Challenge hosted by l’Agence française de développement (AFD), Expertise France, and The GovLab

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Secondary Education: Kenya Needs to Think Beyond 100% Transition

COVID-19 has shown that there is a need for revolutionary thinking within the education sector if all children are to get a chance of an education.

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Secondary Education: Kenya Needs to Think Beyond 100% Transition
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The Ministry of Education in Kenya has continued to push for 100 per cent transition of pupils who sit for the Kenya Certificate of Primary Education (KCPE) examinations in order to ensure that every child gets the full benefits of a secondary education.

Secondary school is the bridge between primary level education and tertiary education whose benefits go beyond attaining a formal education. For instance, secondary education contributes to the reduction of HIV infection among girls, as they are able to delay becoming sexually active and avoid early marriages. Access to a secondary school education also reduces poverty among girls and enhances their chances of employment. Secondary education also benefits the whole society as girls, and the youth in general, spend more time in school, and are therefore less likely to become involved in violence, either as perpetrators or as victims of crime.

Moreover, evidence shows that a secondary education leads to a decline in socio-economic inequality between girls and boys, with secondary education having the most effect on bridging the gap. Furthermore, evidence suggests that children of educated mothers are more likely to progress and complete school than those children whose mothers are not educated. Overall, a secondary education levels the field of opportunity for young people and increases their chances of earning higher incomes and thereby attaining a higher standard of living.

What is the status of enrolment in secondary school?

The status of enrollment in secondary school
Data from the Kenya National Bureau of Statistics shows that between 2016 to 2020 secondary school enrolment by class and sex grew by 8 per cent to about 3,520,000, out of which 50.3 per cent were girls. This increase was attributed to the government’s policy of ensuring 100 per cent transition from primary to secondary school. Looking at the 2020 school year, following the COVID-19 pandemic, Kenya’s total secondary school enrolment decreased from 3.5 million in March 2020 to 3.3 million in March 2021, a 5.7 per cent drop as schools reopened. Moreover, out of those enrolled in March 2020, approximately 233,300 students did not return to school to resume learning when schools reopened in March 2021, representing 6.6 per cent of the students enrolled in March 2020. The number of secondary schools that were able to reopen increased by 0.4 per cent.

A persistent problem

While between 2016 and 2020, there was an increase in the number of pupils transitioning to secondary school, the decrease in enrolment between March 2020 and March 2021 prompted the Ministry of Education to reach out to parents across the country in a bid to ensure that all children returned to school. The drive faced challenges including poverty, poor parental attitudes towards education and ad hoc policy implementation.

Evidence shows that a secondary education leads to a decline in socio-economic inequality between girls and boys.

But by far the most common and most significant challenge to the push for 100 per cent transition to secondary school has been poverty. Many parents say that a lack of resources hinders them from sending their children to secondary school, a challenge that has been exacerbated by the impact of COVID-19 on household incomes across the county. Parental attitudes where for one reason or another parents resist sending their children to school also pose a challenge. Calls for parents’ cooperation from the Cabinet Secretary for Education echo my reflections in a 2018 article where I observed that “bottom-up strategies” may be useful in creating the groundswell for the transition push. This would help avoid the implementation of haphazard policies such as sending government officials around the counties to “drive children back to school”. If parents work with both the national and county governments, they will create a sustained push to ensure that students not only make a transition to the first year of secondary school but that they also stay in school.

Why we may need to reimagine education

Why we may need to re-imagine education
In addition to stimulating an attitude shift in parents, particularly towards their children’s education, it is important that the Ministry of Education, in collaboration with Non-Governmental organizations, develop programmes that can empower the parents financially to keep their children in school. The Advanced Learning Outcomes project (ALOT Change), a community-based initiative by the African Population and Health Research Center (APHRC), has been instrumental in working with parents in Nairobi’s informal settlements so that they can better understand their own roles in the education of their children.

By far the most common and most significant challenge to the push for 100 per cent transition to secondary school has been poverty.

Education stakeholders in both the public and private sector need to work in close partnership to seek better ways of providing scholarships for those children who are in need of school fees support. Through A LOT Change, APHRC has provided subsidies to pupils transitioning to secondary school. The US$ 113 subsidy has been instrumental in decreasing the financial burden of parents, as they are able to purchase books, school uniforms, and other materials required for school. The lessons learned from such programmes can be adopted and scaled up by both the public and private sectors in order to provide relief to parents facing financial challenges.

Some of the students who were “driven back” to the first year of secondary school had to go to school in their primary school uniform. Might it also be time for the education system in Kenya to reconsider the issue of school uniforms? This could also contribute in a small way to reducing the financial burden for parents. Moreover, COVID-19 has shown that there is a need for revolutionary thinking within the education sector if all children are to get a chance an education. The government therefore needs to ensure that schools are better able to take advantage of emerging technologies such as EdTech by, for instance, improving school infrastructure (including computer labs) and access to electricity. This would enable schools to provide both virtual and in-classroom teaching and thus ensure that students get the best of blended learning, linking the finest tenets of in-person and virtual learning.

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Deedha: How Pastoralists Communities Are Effectively Managing Drought and Conflict

With climate trend likely to worsen, it is crucial now for development partners, Civil Society Organizations (CSOs), and policymakers to rethink climate change adaptation and management in light of pastoralist’s indigenous knowledge and traditional resource governance structure such as Deedha to protect pastoralism which has continued to provide a lifeline to millions of households in the horn of Africa.

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Deedha: How Pastoralists Communities Are Effectively Managing Drought and Conflict
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The first known drought in Northern Kenya was about 120 years ago (Wajir 1901, Mandera and Garissa 1902, Tana River 1905, and Isiolo 1927). Since then, 30 major droughts have been recorded in Northern Kenya. While a slow-onset disaster, drought occurrence has reduced to an interval of every 1-2 years in the last two decades.

Despite Africa’s minimal role in global warming, climate risks in Africa are growing bigger and continue to impact negatively rural agriculture and the pastoral economy.

In northern Kenya, drought often results in loss of lives and livelihoods, forcing thousands of households to drop out of pastoralism. Additionally, the Lack of rains undermines the growth of pasture and water availability for both humans and livestock. And as scarcity sets in, the use, control, and access to pasture and water are contested, often leading to risks of violent conflict.

Drought uncertainty triggers an old age survival strategy; – mobility where pastoralists either move to escape drought, conflict, or both. This strategy is incorporated within a traditional resource governance mechanism called Deedha amongst the Borana pastoralists group living in southern Ethiopia and Northern Kenya counties of Isiolo and Marsabit.

Deedha: How Pastoralists Communities Are Effectively Managing Drought and Conflict
Practiced over a century, the system is elaborate; ‘it considers and plans how pasture and water resource’ is planned to last between seasons. Unique and structured, Deedha planning depends on the number of rains received and the pasture regenerated. So effective is the ‘system’ that the knowledge has supported the rearing of cattle to date despite high vulnerability and weak resilience traits.

For a long time in Kenya, cattle keeping has remained synonymous with the Maasai people. Yet in Kenya’s north and southern Ethiopia, the Borana communities have kept cows for equally long periods, so valued attached is that they have family names.

Various groups, including men, women, and young men, have also composed songs praising the cow’s beauty, walking style, milk yields, and how the herd owner moves around with them in the best of rangelands with constant surveillance against the raiders.

So emotive is any cattle disposal plan that a family meeting must be called, where reasons are evaluated to ascertain whether the sale is justified or not.

Another anecdote is also told of how various species respond to different needs, particularly water where camel would stay for a more extended period, followed by goats and sheep and cow in that order. At the same time, this story avers different resilience traits; the Boran has refused to divorce themselves from cattle keeping despite scaled up advocacy on the need for livelihood diversification in the wake of climate change and conflict risks.

Promotes Sustainable use of rangelands

Founded on the principle of sustainable use of the rangelands, the Deedha system is reciprocal. It encourages sharing resources and providing a safe drought haven for other pastoralist groups from other fragile counties such as Wajir, Garissa, Marsabit, Samburu, and even Laikipia.

The system is designed to encourage mobility over large tracts of land, helping the pastoralists break the pest cycle, aerate the soil (breakdown of soil with hooves), and manage unwanted vegetation.

The institution of Deedha is headed primarily by an elder, with each area having its Deedh (traditional grazing area to a particular group), which is linked to other deedha’s.

Informal but highly effective, the Deedha employs critical rangeland management, where the systems consider rangeland planning based on ecological vulnerabilities, livestock populations, an anticipated influx in determining when and where livestock moves, and whether there is a need for activation of the strategic boreholes.

The system partitions the rangeland into three grazing parts as dry, wet, and drought grazing areas, with also flash floods along the Ewaso Ngiro River considered as a season and blessing due to pasture regeneration in the swampy areas. In managing and protecting the rangelands, the Deedha traditional systems discourage sedentarization in strategic rangeland as part of conservation strategy after the use and boreholes areas, where Genset/pumps are mobilized during drought crises and demobilized on the fall of rain.

Manage drought and conflict

The system also incorporates the young people into Deedha resource planning and use and this is for two reasons; undertake pasture and security surveillance (Aburu and shalfa) in the far-flung Deedha’s which borders known or perceived enemy territory.

The system is so unique that critical access planning is done based on anticipated risks and livestock (species) vulnerabilities where Hawich (Milking herd) and non-milking herds (Guess) are split as defined by production and physical traits, respectively.

Hawich (Milking herds) are lactating, and some old and weak female breeds while non-Milking (Gues) are young female and male breeds with the ability to trek long distances searching for pasture and water. The system also calls for the protection of migratory and watering routes. While water for all livestock species is a priority, this customary system prioritized water for livestock in transit and the donkey over other livestock species for its role in household management. The system’s effectiveness has also seen it advocates for the protection of watershed areas and ensuring the cleanliness of the water point environs after all the livestock has been watered.

Deedha: How Pastoralists Communities Are Effectively Managing Drought and Conflict
The Deedha also has in place resource sharing plans internally and externally, where Deedha in one location consult another Deedha before any decision is made. Such arrangement is also captured and advocated for by more recent attempts in enhancing resource sharing and ending conflict through such declaration as the Modogashe-Garissa, first entered in 2001 which calls for strengthening of resource governance and sharing framework between communities during drought. Thus, Deedha proactively enhances resilience through resource sharing and a framework for negotiations between communities during drought.

While Isiolo also had its fair share of drought, the use of this highly effective system has cushioned pastoralist group in Isiolo against the drought, only making foray into other communities’ rangeland in 1992 when Isiolo livestock moved to then Moyale District, Kauro in Samburu in 2000 and 2017 again to Moyale. The migration in 2017 was necessitated by fear following conflict escalation between the Borana and Samburu, leading to loss of 7 lives and over 3000 head of cattle in what the local Borana communities cite as security imbalances created by the Northern Rangeland Trust (NRT) to instil fear and force local pastoralists communities to abandon key strategic drought reserve in Chari Rangelands in favour of wildlife conservancies.

Untold, Deedha also calls for the protection of endangered tree species such as AcaciaAnthath and Qalqalch in which users are not allowed to overexploit, with individuals found out on the wrong punished. Equally, the system put communities at the Centre of wildlife conservation as it discourages reckless killing either for food or even trophies. The system also advocates for leaving water in the trough for wildlife to access in areas where the only water sources are deep wells.

Deedha is an example of bottom-up ‘law or rules’ for rangeland management; it addresses environmental and wildlife conservation. Like in predictive climate science, Deedha elders consider planning on how the previous seasons have performed. Further, the elders can predict trends and rain behaviour patterns based on Uchu, who closely work with the institution of elders.

With climate trend likely to worsen, it is crucial now for development partners, Civil Society Organizations (CSOs), and policymakers to rethink climate change adaptation and management in light of pastoralist’s indigenous knowledge and traditional resource governance structure such as Deedha to protect pastoralism which has continued to provide a lifeline to millions of households in the horn of Africa.

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