AMPATHPlus Hits the Ground Running in Turkana County
AMPATH’S Unprecedented Entry into Turkana County
In August 2019, AMPATH was contracted by USAID to take over HIV care and related activities in Turkana County.
Staff from AMPATHPlus and a Mission Team from USAID paid a courtesy call to Turkana County officials led by the County Sectary and CEC Ministry of Health and Sanitation
Not only was the work enormous, but AMPATHPlus was coming to Turkana on a significantly reduced budget and with higher targets. Achieving more with less money is what Professor Sylvester Kimaiyo, Chief of Party for AMPATHPlus, called “a miracle in the making.”
No road is ever smooth, especially in this part of the country, and AMPATHPlus knows this quite well. Although it is expanding to Turkana with excellent performance in other parts of Kenya, it knows Turkana County is unique and unlike any other.
About Turkana County
A map of Turkana County shows administrative divisions and beautiful Lake Turkana running for 290kms from north to south. It is the world’s largest desert lake and UNESCO defines it as “an outstanding laboratory for the study of plant and animal communities.”
Turkana County is located in the northwestern part of Kenya, bordering South Sudan, Sudan and Ethiopia to the north and Uganda to the west. Turkana is the second largest county in Kenya, occupying half of the former Rift Valley Province.
With approximately 70,000 kilometer square land mass, it is incredibly large and difficult to traverse. “Turkana County is three times the size of all ten of the counties of AMPATHPlus in Western Kenya and North Rift combined,” Kimaiyo said, when analyzing the challenges that now face AMPATHPlus in Turkana County.
Turkana has one of the thinnest population densities in Kenya; about 21 persons per square kilometer. For contrast, one of the other counties that AMPATHPlus works in, Busia County has more than 600 people per square kilometer. Turkana County is also one of the driest and poorest counties with about 9 out of 10 people classified as very poor. Insecurity along its main highways and within borders poses serious challenges to residents and travelers alike.
On top of this, the population practices nomadic pastoralism and in some seasons they migrate as far as Uganda, Ethiopia and Southern Sudan in search of water and pasture. Finding and keeping HIV positive clients under care and treatment is one big problem. Today they are here, tomorrow they are gone and may not be back for months. It is important to ensure that they have enough medication to take along as they move around the region or have an alternative mechanism of accessing drugs along their migratory paths.
Journey to Self-Reliance (J2SR)
Director of Health Dr. Gilchris Lokoel and his deputy Dr. Daniel Esimit Hechakan, lead a committee of six selected from AMPATHPlus and Ministry of Health and Sanitation to advise on partnership arrangements at a meeting with a potential partner in early October 2019.
AMPATHPlus is in Turkana to set a pace for transition of HIV care and treatment services to the County Government. Kimaiyo emphasized the need to build capacity of the County Government Health systems so that they are able to take over all the activities of development partners in what he called the “Journey to Self-Reliance” or J2SR.
From the financial perspective the Journey to Self-Reliance in health will be a matter of setting clear priorities and commitment by the County Government. It requires meticulous planning and inputs by County Health Partners, the Executive and the County Assembly to allocate resource to this process.
As we approach the forthcoming CIDP planning cycles (2023 – 2028) AMPATHPlus needs to engage different arms of government to ensure that this message is clearly communicated and understood so that planning and budgeting include all components of health funding currently funded by development partners.
Representatives from AMPATHPlus and USAID provide mentorship to staff of Kakuma Mission Hospital.
The County Government of Turkana is keen and wants to see this transition taking place as soon as possible. “We want AMPATHPlus to emphasize capacity building, to provide technical assistance and support our County and Sub-county Teams to do their work. All activities should be carried out jointly so that our teams can learn and be ready when AMPATHPlus leaves Turkana,” Director of Health, Dr. GilChrist Lokoel, said.
The County Teams should work alongside development partners, learn about tools and best practices in health, and progressively allocate resources to HIV care and treatment to an extent that they will be the main supporters of health services in the county, replacing part or all of the services currently provided by development partners.
“The target is to ensure that by 2022, the County Government of Turkana takes over HIV prevention, care and treatment services of all or most development partners in the county and receives and spends development funding directly,” Kimaiyo said.
The USAID team that visited Turkana County In mid-October to get reoriented on the status of activities gave this agenda a resounding support. Already the President’s Emergency Fund for Aids Relief (PEPFAR), that has so graciously funded HIV and related care for so many years, has withdrawn support for lab services and blood banks in the country and we are likely to see similar scenarios for HIV care and treatment in the near future.
Home Coming for a Champion
Young Kimaiyo shown as a teacher in Lorugum Girls in the ‘70s.
No one was more thrilled about the prospects of working with Turkana people than Kimaiyo.
“I am excited and proud to be part of a support system to the people of Turkana. Turkana County is my second home. I started high school here in the 70’s and worked with the Ursuline Sisters to start Lorugum Girls School after I completed my secondary education in Lodwar Boys (school). I didn’t need a second of persuasion to come over here to help the people of Turkana,” Kimaiyo said.
Professor Kimaiyo was applauded countless times when he mentioned his early years in Lodwar Boys, and being a lecturer to some senior health officials currently working with the County Government of Turkana. Some senior officials too had a tale about an encounter with the witty Professor as a lecturer at Moi University and as the first ‘Turkana Boy’ to earn a medical degree
Since coming back to Turkana County, Kimaiyo had been thinking of visiting both Lodwar Boys and Lorugum Girls (schools) but had been unable due to heavy engagement in the Turkana program launch and work of AMPATHPlus in other counties. However, on October 17th, he decided to make a surprise visit to Lorugum Girls while on a visit to a health facility in the vicinity. He did not inform anybody about his impending visit and was not accompanied by any of his colleagues.
What he thought would have been a quiet affair turned out to be a rousing welcome and a noisy rumble when he arrived at the school where met a troop of sisters, teachers, students and workers waiting for him at the gate. The school had not changed much in infrastructure, but reaching the school was much easier compared to forty years ago. He recalls walking all day to the school without a single drop of water.
Forty years is a long time. He did not expect to meet with anyone he knew from in his early days at Lorugum Girls, but was amazed to see a gentleman who in those days was nick-named the “Energy Engineer” owing to his skills in lighting the oven-fire. He was still there doing the same exemplary job and much to Kimaiyo’s surprise he remembered him.
Deputy Director of Health, Dr. Esimit Hechakan and Professor Kimaiyo of AMPATHPlus consulting during a meeting between Ministry of Health, AMPATHPlus and USAID teams.
The Last Mile Dash
The last two months have enabled the program to share its vision and mission with stakeholders in Turkana County. Ongoing lessons have also fed into the design of the program.
An important approach to AMPATHPlus work in Turkana has been the need to realign most of the program areas to the Ministry of Health delivery systems and demonstrate AMPATHPlus goal of supporting local ownership and accountability for all program results.
We believe that with passionate and committed leadership deeply connected to Turkana people, as well as the performance and track record of AMPATHPlus in HIV care and treatment, and a rich base of expertise in program delivery infused with local talent, AMPATH will succeed in bringing all people living with HIV in Turkana County under care.
Thanks to reporting from Sammy Keter, AMPATHPlus, Lodwar