A Review of Good Practice and Lessons Learned in Programming for ASAL Populations in the Horn of

Africa

For UNICEF ESARO

Katharine Downie, PhD September 2011

Table of Contents

Background and Context_______________________________________________1

Introduction ____________________________________________________________ 1

Why focus on pastoralists in the quest for equity of service provision? ____________ 3 Lack of Access to Basic Services__________________________________________________3 Health of Pastoralists ___________________________________________________________4 Education and Pastoralists _______________________________________________________4 Marginalisation of Pastoralists in Government Policy and Practice _______________________5 Contribution of Pastoralist Livelihoods to Regional (HoA) Economies ____________________6

Why focus on livestock when addressing pastoralist wellbeing?__________________ 8

Purpose of Synthesis Exercise__________________________________________10

A Review of Good Practice in Programming for Pastoralists _________________10

What is Good Practice? __________________________________________________ 10

Health provision to pastoralists – external agencies experience _________________ 12 The “One Health” Approach ____________________________________________________12 Joint Vaccination Campaigns in Chad _____________________________________________13 The provision of combined static and mobile health services ___________________________14 Community Animal Health Workers (CAHWs), Community Health Workers (CHWs) and Traditional Birth Attendants (TBAs) ______________________________________________16

Health provision to pastoralists – the UNICEF Experience_____________________ 19 Child Health Days in Somalia (CHD) _____________________________________________19 Long Lasting Insecticide Treated Nets (LLIN) in Karamoja ____________________________21

Food Security and Livelihoods _________________________________________22

External Agency Experience in Food Security _______________________________ 24 Pastoralist Areas Coordination Analysis and Policy Support (PACAPS) Early Warning/Early Response (EW/ER) Mandera Triangle strategy for pastoral communities _________________24 Save the Children’s Africa Regional Pastoral Initiative - Pastoral Health and Nutrition Initiative (PHNI): Milk Matters _________________________________________________________26 Disaster Risk Reduction in Mitigation of Food Insecurity in Ethiopia ____________________28

Education __________________________________________________________31

External Agency Experience ______________________________________________ 31 Tent Schools in Iran___________________________________________________________31 Distance Learning for Women in the Gobi Desert____________________________________32

Education - UNICEF Experience __________________________________________ 34 North-eastern Province Girls Scholarship Education Program in Kenya___________________34 Flexible Approach to Basic Education (FABE) in partnership with Africa Educational Trust (AET), Horn Relief and Save the Children in Puntland________________________________35 Pastoral Youth Leadership in Puntland in partnership with Horn Relief___________________35 Alternative Basic Education Centres in Karamoja, Uganda (ABEK) _____________________37

WASH activities _____________________________________________________40

Social Protection ____________________________________________________41

Experience of External Agencies __________________________________________ 41 Livestock and Health Insurance__________________________________________________42 Training for Income Diversification ______________________________________________42 Safety Net and Cash Assistance Programmes _______________________________________43

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Recommendations ___________________________________________________44

References _________________________________________________________46

List of Figures Figure 1: Social service coverage of pastoralists in eastern Africa, compared to national averages of countries in eastern Africa _____________________________4 Figure 2: Focus on Pastoralists and Equity_________________________________7 Figure 3: Livestock and Pastoralist Wellbeing ______________________________9 Figure 4: What is Good Practice? _______________________________________12 Figure 5: Good Practice in Health Service Provision - External Agency _________19 Figure 6: Good Practice in Health Provision - UNICEF______________________22 Figure 7: Good Practice in Food Security and Livelihoods Interventions - External Agency_____________________________________________________________30 Figure 8: Good Practice in Provision of Education - External Agency___________34 Figure 9: Good Practice in Provision of Education - UNICEF_________________39 Figure 10: Good Practice in WASH interventions ___________________________41 Figure 11: Good Practice in Social Protection Interventions __________________43 Figure 12: Schematic for Good Practice __________________________________45

Background and Context

“For many decades, governments regarded pastoralism as ‘backward’,

economically inefficient and environmentally destructive, leading to policies that

have served to marginalise and undermine pastoralist systems. More recently,

pastoralism has come to be regarded by many as a viable and economically effective

livestock production system, but the policies needed to reverse its historical

marginalisation and address the chronic levels of poverty and vulnerability faced by

many pastoralist communities have yet to be put in place.” (Chinogwenya &

Hobson, 2009)

Introduction

As part of its strategy to deliver more effective programming in the Horn of Africa for

pastoralists and people who live in Arid and semi-Arid Lands, UNICEF seeks to

review its current practices in delivery of health, nutrition, education, water and

sanitation and social protection programmes and look closely at what other agencies

are also doing in this field with a view to learning from both its own and external

experience in order to deliver services from which pastoralist communities can derive

the most benefit.

This review of UNICEF good practice and lessons learnt was taken from six countries

in the HoA; Djibouti, Eritrea, Ethiopia, Kenya, Somalia and Uganda (Karamoja) and

the external agency review of good practice and lessons learnt employed examples

from pastoralist and ASAL communities around the world. One of the factors

hindering a comprehensive review was the lack of information on activities. While

Country Offices furnished examples of work that was ongoing or had been carried out

tailored to pastoralists, this information was not comprehensive and did not come

from all COs. In some cases, activities such as a cost/benefit analysis of mobile health

clinics in Ethiopia were indicated in planning by Terms of Reference but there was

little evidence as to whether this had been carried out and what the results of this

analysis were.

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Current initiatives in UNICEF programming for women and children in all sectors

suggest that good practice is being implemented, however, this opinion is based on

anecdotal rather than empirical evidence. From a review of activities in pastoralist

communities being carried out by UNICEF in the HoA, it was extremely difficult to

assess the impact (and therefore potential good practice) of these interventions as

there were very few evaluations and thus very few indicators of impact of these

interventions. Impact would then necessarily inform lessons learned which would

feed back into programme design.

It should be noted however, that the Evaluation of Child Health Days in Somalia,

carried out by UNICEF and WHO, did produce valuable data to be used in informing

practice. The evaluation also indicated that this intervention was both cost-effective

and had an impact on improving child morbidity and mortality in Somalia.

Activities reviewed included those in all sectors; mobile schools, mobile health

clinics, nutrition activities such as supplementary feeding, WASH activities such as

water point rehabilitation and social protection programmes such as emergency cash

transfers and vouchers. In comparison to other sectors, however, it was noted that

there were relatively few WASH activities specifically geared to pastoralist

populations being carried out. Given that UNICEF is the lead actor in the Global

WASH cluster and that water and hygiene are crucial elements in the welfare of both

pastoralists and their livestock, it would be prudent to understand whether this

absence occurs as a result of a lack of investment in analysis with respect to relevance

and importance, a lack of technical capacity within the resources for programming or

other reasons.

It should be mentioned that in addition to few evaluations, there was no evidence of

risk or vulnerability assessments being carried out prior to implementation of

interventions and no analysis of the relationship between livelihoods and other sectors

such as nutrition, education and health.

Although livestock livelihoods play a crucial role in the wellbeing of pastoral

communities, IDPs and refugees in the HoA, there was little evidence to suggest that

sectoral programming had been done taking into account the role they play.

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Information from livelihoods analysis frameworks such as the Household Economy

Approach or the Sustainable Livelihoods Framework which could be incorporated to

build intersectoral capacity to withstand potential shocks by good practice in

programming, was not in evidence.

Overall, there is little evidence-based analysis and the use of monitoring and

evaluation data to inform better programming. In many cases, data does exist and

resides with agencies such as FAO, FSNAU, regional governments or within early

warning systems but it is not being used in a coordinated fashion to build the

resilience and capacity of communities in programming for risk mitigation. As one of

the key elements in preventing future catastrophic emergencies, particularly

influenced by drought or floods in the HoA is to build the capacity of communities to

withstand the effects of drought on the nutrition and health of women and children, it

is vital that systems and therefore programmatic direction, are in place which reflect

an understanding of the causes of vulnerability in the region as associated with

livelihoods, conflict and climate change in pastoralist lives. The coordinated use of

monitoring and evaluation data to adopt develop social protection initiatives,

influence relevant curricula in education and gain a better understanding of

relationships between animal and human nutrition and wellbeing is essential to coping

with the effects of drought and other disasters in such a way that famine is not an

inevitable consequence.

Why focus on pastoralists in the quest for equity of service

provision?

Lack of Access to Basic Services

The lack of service delivery to pastoralists is widely acknowledged to be one of the

most evident processes of marginalization and exclusion by governments and policy

makers (Schelling et al., 2008a). The table below illustrates pastoralists access to

social services in three countries in the Horn of Africa; Kenya, Ethiopia and Sudan

illustrating the extent to which these communities are falling behind in basic

indicators of well-being.

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Figure 1: Social service coverage of pastoralists in eastern Africa, compared to national averages of countries in eastern Africa

Source: (Ali & Hobson, 2009)

Health of Pastoralists

When compared, the diseases and health conditions in mobile populations do not

differ substantially from those of sedentary populations, but pastoralists suffer higher

Infant MR, Maternal MR, and higher U5MR (Chabasse et al., 1985; Brainard, 1986;

Munch, 2007). Pastoralist groups may be more frequently affected by water-borne

diseases (parasitic or bacteriologic) as they consume surface water more often than

settled groups (Bonfiglioli, 1990) and can be susceptible to zoonotic diseases such as

brucellosis, Q-fever, bovine tuberculosis and botulism due to their association with

and consumption of raw, unpasteurized milk (Smith et al., 1979; Schelling et al.,

2003). In addition, mobility and dispersion can influence the spread of disease

(Loutan, 1989) and therefore enhance risk for mobile populations. For example, the

transmission of measles amongst the Tuareg people of Niger is reported to be low due

to their dispersion, but individually, due to poor vaccination coverage, these people

can act as reservoirs of disease, and therefore pose a risk to those with whom they

come into contact (Loutan & Paillard, 1992).

Education and Pastoralists

While recently governments, policy makers and pastoralists themselves have realized

the importance of education programmes for mobile populations, barriers to accessing

quality and relevant programmes remain high. Although solutions to problems with

attendance caused by mobility such as boarding schools, mobile school programmes

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and non-formal education programmes have been met with some success, sparse and

infrequent attendance due to labour demands in the household (Kratli & Dyer, 2006),

perceived irrelevant curricula, problems with gender inequality due to cultural taboos

(Admassie, 2002) or the demands of herding for boys (Carr-Hill, 2006) and lack of

sustainability due to funding restrictions (Carr-Hill, 2006), limit the impact of

education on the population. Examples of innovative approaches to provision of

education will be discussed further in this review.

Marginalisation of Pastoralists in Government Policy and Practice

Pastoralists have traditionally suffered from a lack of representation in governments

in the HoA, a situation which has led to development of policies that have adversely

affected their lifestyles and access to public services. While some of these policies are

more deliberate and set out to change pastoralist lifestyles, others are harmful more by

omission or exclusion of pastoralist needs.

Up until about 15 years ago and in some countries still practiced today, governments

and policies focused on settling mobile populations, restricting herd sizes and

restricting access to natural resources (de Waal, 1991; Korwa, 1993). Settled

communities are better represented in government structures and as a result are better

served by social services and infrastructure such as schools, markets and health care

than do mobile communities. Governments are able to enumerate and therefore tax

settled communities, thus making the provision of services, in their eyes, more cost-

effective (Little et al., 2006). The process of sedentarisation or “villagisation” is still

advocated in some countries in sub-Saharan Africa, such as Ethiopia, Djibouti and

Tanzania , with governments promising better access to basic services, on the

condition that pastoralists remain settled (Oxfam GB, 2009).

Modern-day policies continue to allow appropriation of pastoral rangelands, with

associated displacement and impoverishment of pastoralists. Rangeland is taken over

by farmers in countries where sedentary crop production is seen as preferable to

livestock production; pastoral land is allocated to private companies for commercial

agriculture, especially in riverine areas which are often critical dry season resources

for pastoralists; pastoralists are excluded from wildlife conservation areas which were

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formerly traditional rangelands; and pastoralists are displaced due to large scale

irrigation schemes.

In eastern and southern Africa there are no specific pastoral policies or laws that

explicitly address pastoral land tenure issues. Instead pastoral land tenure, when

addressed, falls under other policy instruments and laws such as a national

constitution or poverty reduction strategies, or as a sub-component of national sector-

based laws on land, forests or the environment (AU, 2010).

Contribution of Pastoralist Livelihoods to Regional (HoA) Economies

Some governments and policy makers have now understood that the livestock that

pastoralists depend on can contribute significantly to their countries’ economies, if all

elements are properly managed. In economic terms, pastoralism contributes

significantly to the HoA’s agricultural Gross Domestic Product (GDP), including 35%

of agricultural GDP in Kenya, Ethiopia and Sudan. It is estimated that meat supplied

from pastoral rangelands account for 99% of consumption in Djibouti, 52% in Eritrea,

14% in Ethiopia, 36% in Kenya and 46% in Sudan. Milk production in pastoral

rangelands also contributes significantly, both to GDP and food security in the region,

with approximately 75% of milk consumed locally. Taxation on marketed livestock

and livestock products also accounts for a significant percentage of local and national

revenues, with the pastoral sector accounting for almost all revenues in key dryland

zones throughout the region. Ironically, however, the ratio of contribution to

government revenues and allocation of public spending to pastoral development in

these same regions stands at 10:1, despite its proven importance (COMESA, 2009).

Pastoralism has also been shown to contribute appreciably to agricultural Gross

Domestic Product (GDP); in many Sahelian, Central and Inner Asian countries up to

80%, and this contribution increases further when considering indirect benefits such

as manure for crop farming, wildlife conservation and tourism (Pratt et al., 1997;

WISP, 2007). The livestock sector in non-OECD countries is growing at a rate of up

to 7% per annum - much faster than the agricultural sector as a whole, and by 2020 it

is predicted to be the most important sub-sector in terms of added value (Scoones &

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Wolmer, 2006). In Ethiopia, for example, the size of the economy is much larger than

usually reported. The volume of animals traded and exported via informal trading

routes significantly exceeds the volume of animals exported through official channels.

A recent study estimates that informal cross-border exports from northern Somali

Region alone exceed by a factor of 3.2 to 6.5 the Ethiopian Customs Authority’s

statistics for the number of live animals exported from the whole of Ethiopia (PCI,

2007).

Figure 2: Focus on Pastoralists and Equity

Pastoralism has been shown to contribute significantly to GDP in HoA countries both in meat products and milk production. Despite this obvious economic value, the ratio of contribution to government revenue and allocated public spending to pastoral development remains at 10:1. 

 

Summary Box: Why focus on pastoralists to redress the balance of inequity of service provision?  Lack of access to social services over time has resulted in pastoralists lagging significantly when compared to other sedentary populations in the region, in basic indicators of well‐being such as literacy rates, immunization coverage, infant, under five and maternal mortality rates and school enrollment rates.  Pastoralists continue to be marginalized by government development policies; sometimes with a purpose of transforming their lifestyles from nomadic to settled and sometimes simply by the requisite protective policies to maintain their way of life being omitted. Pastoralists are also often not represented in government censuses, demographic surveys and other baseline data collection exercises. 

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Why focus on livestock when addressing pastoralist wellbeing?

Livestock play an integral part in not only the way of life for pastoralists, but also

their livelihoods as they are almost entirely dependent on them. It is for this reason

that any interventions in health, water and sanitation, nutrition and education must

take into account the importance and role of livestock in pastoral livelihoods and

well-being. Livestock perform multiple roles: they provide income and cash through

the sale of live animals and animal products, in particular, dairy and feed the

household (milk, meat and blood). In some parts of Northern Kenya, livestock and

milk and milk products represent 100% of total annual income (COMESA, 2009);. In

addition, they are used for transport, traction and the provision of manure. They hold

an intrinsic aesthetic value in pastoral societies; livestock are a reflection of wealth

and status within that society (Lewis, 1994) and are used to cement social ties in bride

prices and other transactions. The health of a pastoralist’s livestock is as important as

the health of his/her children (Schelling et al., 2008a).

Livestock can also play a crucial role in reconstruction and recovery following

conflicts or environmental catastrophes. In contrast to crops, livestock such as camels,

cows, sheep, goats and chickens make an immediate contribution to the food supply,

thus providing a bridge for the household until the first harvest (Reist et al., 2007).

Livestock restocking to pre-conflict herd size is a viable recovery strategy, however, it

must be remembered that the minimum time for this recover is 3, 10 and 12 years for

goats, cattle and camel owners respectively (Simpkin, 2005).

Given the importance of livestock to pastoralists, when designing interventions for

mobile populations, livestock health can act as a gateway to human public

interventions. In some mobile communities in Chad, more people have skills required

to care for animals than they do for addressing human health needs (Weise & Tanner,

2000). Livestock veterinary interventions such as a dual vaccination campaign for

both animals and humans can not only reduce costs but serve to build trust within

communities as they see the care and attention given to their animals. Examples of

this can be seen in campaigns in Chad (Schelling et al., 2007) and the practice of

implementing human health activities following successful treatment of animals in the

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Greater Horn of Africa (Catley, 1999). Multi-sectoral livelihoods approaches that

address water provision for animals and water safety and provision for humans, in

addition to addressing supplementary feeding programmes for livestock and humans

can often be more successful than those dealing with animals and humans separately.

A more detailed examination of the “One Health” concept will be explored further in

this paper.

According to proponents of “The Livestock Revolution”, (Delgado et al., 1999) which

postulates that the combination of population growth, rising per capita incomes, and

progressive urbanization are creating an unprecedented growth in demand for food of

animal origin in developing countries, giving rise to major opportunities and threats

for mankind, pastoralists will play an important role in meeting this demand. In order

to maximize benefits from this growing demand, pastoralists will need to control their

producer and market chains, including food safety standards awareness, thus requiring

education imparting skills in literacy and numeracy and the regulation of the health of

their animals. Appropriately delivered and suitable interventions in both of these areas

would enhance pastoralists’ opportunities.

Figure 3: Livestock and Pastoralist Wellbeing

Livestock can play a vital role in recovery following a drought or other disaster. Purchase of livestock such as goats, chicken, cattle and camels makes an immediate contribution to food supply, unlike crops.  Given the importance and investment to pastoralists in the health of their livestock, opportunities exist to combine animal and human health activities. These can include dual vaccination and de‐worming campaigns, WASH interventions and entry points for monitoring nutrition and child and maternal health.  According to the “Livestock Revolution”, the demand for products of animal origin will significantly increase in the near future in developing countries. With this growing demand will come disease threats, health and safety issues and the need to control producer and market chains. It will therefore be necessary to be closely involved in enabling pastoralists’ participation by ensuring access to basic services such as health, education and water and sanitation; thus adequately equipping them to contribute. 

 

Pastoralists are almost entirely directly dependent on their livestock for health and nutrition. Income from sales of livestock and livestock based products (dairy, dried meat) buys grain to supplement diets, medicine and health care and other household products. 

 Summary Box: Why focus on livestock when addressing pastoralist wellbeing? 

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Purpose of Synthesis Exercise

In keeping with the IASC Plan of Action for the HoA, which emphasizes a change in

the donor emergency paradigm from crisis response to crisis prevention, this

document will focus on how building sustainable livelihoods for pastoralists can

mitigate the impact of known cyclical crises and what has worked in programming for

pastoralists in the past and present. Much of the IASC Plan looks at how addressing

the root causes of food insecurity can alleviate humanitarian response to crises. Some

of this is being done by developing Comprehensive Africa Agriculture Development

Programmes (CAADPs), which focus primarily on sedentary agriculturalists, but the

IASC Plan of Action also stresses the need to examine the CAADPs with respect to

their “humanitarian value” and look at specific needs of pastoralist communities.

The purpose of this paper is to present a synthesis of programming initiatives in

health, nutrition, education, WASH and social protection activities, which illustrate

good practice in programming, drawing on those activities implemented by UNICEF

and also those within other agency experience, focusing on provision of interventions

for pastoralist groups around the world. The focus of this synthesis with relevance to

UNICEF experience is six countries in the Horn of Africa; Djibouti, Eritrea, Ethiopia,

Kenya, Somalia and Uganda and is disaggregated by sector.

A Review of Good Practice in Programming for

Pastoralists

What is Good Practice?

Elements of good practice can be seen as guiding principles to plan more effective

interventions. Key facets of good practice, gathered from reviewed literature,

including the One Health approach, are as follows:

1. Ensure deep and meaningful participation of pastoralists at all stages of project

design:

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This implies participation at the earliest stages of problem setting and throughout the

project cycle. Participation is for the sake of wider empowerment and not only to

ensure that project activities are tolerated by communities but that they occur at

appropriate times during the year and take into account seasonality affecting

livelihoods and priorities and preferences . Participatory assessment must gather

information on the main characteristics of the barriers to social services, on

community priorities and preferences, and on an exhaustive analysis of primary

stakeholders. Community participation in planning health and education provision

will empower community members to voice their needs and, later on, allow them to

pursue their own initiatives to improve access to the services they desire. Participatory

monitoring and evaluation of activities should constitute the basis for scaling up

appropriate interventions and appropriate policy formulation.

2. Adopt an innovative and adaptive approach

Appropriate attention should be given to community-based services, such as

community health workers, traditional birth attendants and teachers, but with close

attention to the quality of services and to ensuring their continuation beyond the

duration of project support (sustainability). Innovations such as combining mobile and

static health services and provision of dual animal and human interventions are a

proven way to link pastoralists with formal service provision. Projects also need the

capability and space for flexibility, for example with regard to school calendars and

timetables for pastoral children and for health centres to consider by-passing

pastoralists, and teachers need training to adapt curricula to the pastoral setting.

Flexibility should also be exercised in identifying alternative solutions, and inter-

sectoral collaboration should be pursued where relevant.

3. Ensure cultural sensitivity

Teachers and health workers should ideally be recruited from within the community,

but where this recruitment cannot supply the required numbers, the quality service

provision can be improved if all personnel are trained to be culturally sensitive to their

clients’ needs. Women’s needs have to be addressed in particular in project

development, since women face particular challenges in access services (Schelling et

al., 2008a). Communities’ perceptions of illness and disease which may prejudice

against or deter seeking treatment from modern health practitioners must also be taken

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into consideration when designing effective interventions. For example, a mother who

believes her child’s polio was inflicted by witchcraft –conditions that affect an

individual’s mobility, essential to the pastoralist way of life, are commonly attributed

to negative supernatural forces – may not go out of her way to bring her children to a

polio immunisation campaign (Reidy, 2010).

4. Ensure cost effectiveness and impact

Good practice must include a cost/benefit analysis of interventions to ensure they are

cost-effective in improving delivery of service to ASAL populations. While cost-

effectiveness should remain a priority for long-term sustainability of building

resilience and capacity into populations, in the bid to achieve equity with other

sedentary populations, initially, given the current gap in spending of development

funds on pastoralist populations versus other more sedentary groups, more funds

overall could be devoted to ASAL interventions. This does not lose sight of the

importance of individual interventions being cost-effective for sustainability long-

term. Evaluations therefore need to be carried out regularly on activities to ensure

their cost-effectiveness and the impact they have on the sectoral core indicators of

well-being.

Figure 4: What is Good Practice?

Summary Box: What is Good Practice?  

1. Ensure deep and meaningful participation of pastoralists at all stages of project design. 

2. Adopt an innovative and adaptive approach. 3. Ensure cultural sensitivity. 4. Ensure cost‐effectiveness and impact. 

Health provision to pastoralists – external agencies experience

The “One Health” Approach

The concept of One Health evolved from One Medicine, an approach pioneered by

Calvin Schwabe, an American epidemiologist whose work with the Sudanese Dinka

pastoralist healers caused him to examine the synergies of human and veterinary

medicines and the added public health benefits of using a combined approach. One

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Health operates on the premise that the cooperation between human and veterinary

medicine to protect and improve animal and human health, such as the collaborative

efforts made by agencies when investigation SARS and avian flu can lead to a more

holistic understanding of disease causes and pathology and therefore enhance

preventive and curative measures. An intersectoral human and animal health approach

is particularly applicable in a pastoralist context where animals play such a crucial

role in livelihoods. Nomadic pastoralists trust providers who exhibit successful

treatment of their livestock, their most respected commodity and in some countries,

animal health workers and services are more prevalent than human health services.

Joint Vaccination Campaigns in Chad

Animal health as a gateway to human health provision is a strategy that has met with

some success. In Chad, simultaneous assessments of the health status of people and

animals in nomadic pastoralists showed not one fully immunised nomadic child or

woman; on the other hand, cattle were largely vaccinated because of compulsory

vaccination campaigns (Bechir et al., 2004; Schelling et al., 2007). Preventive

veterinary measures were designed at the outset to reach mobile populations, but

public-health services were restricted to static health centres, failing to account for

mobile lifestyles (Zinsstag et al., 2005).

A project of the Swiss Tropical Institute supported the implementation of several joint

campaigns and played a facilitating role in harmonising the timing of activities of the

public health and veterinary services. Between 2000 and 2005, 14 vaccination

campaigns for nomadic children, women and the camp’s livestock were carried out

among the three principal nomadic ethnic groups (Fulani, Arabs and Dazagada) in the

Chari-Baguirmi and Kanem of West-Chad. Each campaign was composed of three

vaccination rounds for children and women to assure a complete course of vaccination

of children in one year. The capacity of existing mobile veterinary teams was

extended for simultaneous vaccination of people and animals during at least one

round for 10 of the 14 campaigns.

Veterinarians vaccinated 149,255 livestock against anthrax, pasteurellosis, blackleg,

and contagious bovine pleuropneumonia. After 3 visits from the vaccination team,

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4,653 children <5 years of age were fully immunized against diphtheria, whooping

cough (pertussis), and tetanus (DPT) and against polio; 7,703 women received at least

2 doses of tetanus vaccine (TT2+). The average dropout rate within a given campaign

was 64% for children <5 years from the first to third vaccination for polio and DPT

within a given campaign and 32% for women from the first to second

dose of tetanus vaccine. Although these campaigns showed high drop out rates of

children and women, drop out was very rarely due to refusal to be vaccinated, but

rather due to the high mobility of pastoralists – a chronic problem. Achieving lower

drop out rates remains a critical need, however vaccination of DPT and polio can

continue in subsequent campaigns and one vaccination is effective in immunizing

children against measles and yellow fever.

Pastoralist communities highly valued the combined approach that considers the

health of their family members and of their livestock. In addition to anecdotal positive

feedback from pastoralists and health and veterinary personnel, the data collected

during the 14 campaigns showed a higher mean of persons vaccinated per day for

combined livestock/human vaccination days versus human only days. A key

statement repeatedly made by nomadic parents was, “Measles and whooping cough

have disappeared among nomads, although it remains at the market-sites we visit.

And when we attend markets, we no longer contaminate our camps with these

diseases.”(Schelling et al., 2007).

The provision of combined static and mobile health services

It is difficult to sustain health services within a community with mobile service

provision for any length of time as these services are both costly and logistically

problematic to organise. In addition, outreach services of health centres specifically

including bypassing mobile groups are rare – likely owing to the health centres’

annual planning of materials and drugs that does not foresee other groups than those

sedentary communities in their zone of responsibility (Schelling et al., 2008b). The

most successful human and animal health services for nomadic pastoralists combine

fixed and mobile facilities, incorporating local knowledge and specialisation where

appropriate.

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The African Medical and Research Foundation (AMREF) has over thirty years

experience in delivering mobile health services. Dr Basil King, the Head of the

Nomadic Health Unit for AMREF established mobile health services for the Maasai

in Kenya in the early 1950s and these continued until the early 1990s, until they were

stopped for a number of reasons, the main one being cost (personal communication

from Basil King). The first evaluation in 1984 found the achievements of the mobile

clinics remarkable. However, it also found that activities depended upon the dedicated

work of two nurses, that the clinics were expensive, were not replicable and were not

sustainable in the long-term. Another criticism was the top-down administration of the

programme – the activities were based in Nairobi and that the communities served by

the clinics were not actively involved. Two more evaluations in 1989 and 1991 came

to similar conclusions. Consequently AMREF closed the mobile services and

provided health services from a static dispensary within Maasailand (King, 2000).The

experience of high costs is borne out by that in other communities in West Africa

where it was found that mobile health services had more-fold costs than static facility

services (Brenzel & Claquin, 1994) - particularly if operating independently from

static health facilities (Aliou, 1992). AMREF worked closely with the Kenyan

Ministry of Health and set up curative and preventive health care services, including

maternal health and basic medical laboratories. The outreach services were targeted to

the most common diseases such as malaria, diarrhoea and respiratory diseases of

young and adult pastoralists and included immunization campaigns. Severe cases

were referred to static health facilities.

In the Agadez region of Niger, three different pilot health interventions for nomadic

pastoralists have been tested. In 1968, mobile units were set up but exhibited poor

performance and high costs. In 1971, fixed health structures were built next to

pastoral zones, but utilisation by nomads was infrequent. Finally, in 1988 the

Expanded Programme on Immunization (EPI) linked the static with mobile delivery

structures and the outcome both in terms of reached people (e.g. 40% of BCG

coverage) and costs were more favourable than the single approaches (Aliou, 1992).

Such a combined approach between mobile and static services is also promoted in

other projects to make best use of existing infrastructure and human resources. The

experience in Chad is that during the mobile vaccination services, the pastoralists

perceive the quality services that are offered at the health centres and start to trust the

15

health providers. The public health sector was thus able to use the mobile campaigns

as a gateway to the pastoralists and increasingly, nomadic parents visited health

centres with their children for treatment and prevention (Schelling et al., 2008b).

Community Animal Health Workers (CAHWs), Community Health

Workers (CHWs) and Traditional Birth Attendants (TBAs)

The Pastoralist Development Project (PDP) also has experience with provision of

mobile health services using a slightly different model. Although originally set up as a

camel improvement project, in 1993, when the mobile camps had become

increasingly immobile due to their size and services offered, a special outreach

service (SOS) was established in which project staff travelled on foot with camels,

carrying food, water and equipment, to visit nomadic populations many miles from

the nearest roads or communication lines. In 1996/97, the community-based animal

health workers (CBAHWs), community health workers (CHWs) and traditional birth

attendants (TBAs), who had been trained by FARM-Africa and other projects, were

supported to carry out these special outreach services. The foot safaris lasted 7 to 10

days and could cover up to 210 km in a radius as far as 50 km from the mobile camp.

The trained personnel treated both humans and animals when necessary and provided

extension advice in the evenings.

Evaluation of the SOS established some drawbacks with service provision. These

security, adverse weather and time required. The weather, particularly heavy rain or

prolonged drought, physically affected movement of the SOS staff and that of the

pastoralists. Trying to treat livestock or human patients early in the day or late in the

evening affected travel time and forced the teams to travel in the heat of the day. In

some cases, the team arrived at a nomadic camp to find the inhabitants ready to

migrate. Other problems included the lack of suitable hiking and camping equipment,

and how to provide a service for people who did not have cash at hand. All services

were to be paid for, and yet it was common in a remote camp to find a person or an

animal needing treatment but without available cash to pay for drugs or services.

Although the owner was often willing to pay in goats, the team had no means of

recuperating the cash. Staff had to decide whether to refuse treatment or to treat for

free and risk creating an attitude of dependency (FARM-Africa, 2002).

16

Further to the SOS initiative, and in its third phase of the project, FARM-Africa

embarked on a much bigger project which trained and supported 230 CHWs/TBAs

and 160 community-based animal health workers CBAHWs to provide basic services

to their communities. The project recruited community nurses to train the CHWs and

TBAs. The service providers were given micro-enterprise management training and

encouraged to charge fees for their services. Immunization of children and the

laboratory to provide primary health care dropped because these were not sustainable.

The majority of CHWs and almost all TBAs were women. Eight women were trained

as CBAHWs. Sector based district forums were set up to discuss common issues and

approaches in training standards and curriculum content for quality control.

Encouraged by the governmental services, the project supported the formation of

village health committees to monitor and oversee the CHWs.

Of the 240 CHWs and TBAs who were trained, 60 were prepared to invest in drug

kits costing less than $200 and 72 were receiving drugs through the Ministry of

Health or chemists and providing basic services. An important function of CHWs was

to identify people with serious illnesses and refer them to well equipped clinics or

hospitals for appropriate treatment (in 1999 300 patients). CHWs were running five

government dispensaries in Marsabit and Moyale Districts, with supervision from the

project and the government, and the CHWs were providing up to 95% of all basic

health services such as treatment against malaria, diarrhoea, worms and eye

infections, effectively displacing the untrained shopkeepers who had sold drugs.

Small groups of CHWs pooled their resources together to establish six drug stores and

three village pharmacies. Although both CHWs and CBAHWs grappled with issues of

financial sustainability, some progress was made through joint ventures organised by

three or four CHWs and CBAHWs.

CHWs provided also basic advice to villagers on health and hygiene, including the

construction of pit latrines and racks resulting in a decline in hygiene-related diseases.

There was also a significant reduction in scabies, conjunctivitis and diarrhoea. 120

TBAs delivered up to 500 babies annually, with mothers were receiving ante-natal

care and advice on the importance of vaccinations (subsequently, over 90% of the

children were being taken to health centres for their vaccinations). Mothers

17

18

experiencing complications were noted early and referred to health centres. The

mobile outreach camp approach which caters for pastoralists and their livestock using

community-based animal and human health workers was reproduced in Tanzania and

Ethiopia and has been scaled up through the World Bank/IFAD Ethiopian Pastoral

Development Project (FARM-Africa, 2002; Schelling et al., 2008a).

Experience in Marsabit District in Northern Kenya has shown that employing already

practicing traditional healers as CHWs and TBAs can reduce the risk of posts being

abandoned due to lack of remuneration. The best choice of community health workers

for pastoral communities is the traditional health practitioners, who are already

offering health care at this level. Once they are given a basic training as that required

for conventional community health workers, and once they are formally recognised as

‘community doctors’, they could be more productive and deliver a better quality of

care. Their training should focus on areas such as maternal and child health services,

antenatal care, AIDS prevention and education on preventive and promotive care such

as diarrhoeal disease control, as well as that of the zoonoses such as brucellosis and

anthrax. The reason for this advocacy is that traditional health practitioners are

reliable people who are already working in the community, offering the same

services. They are recognised and accepted by the community and there is less chance

of them abandoning the service, since they do not fully depend on it as a means of

living. In addition, most of them perform a dual role in both human and animal health

care. They could therefore be used for both purposes as long as they are willing to be

trained. Experience so far shows that the traditional birth attendants are willing to be

trained and the other groups (herbalists, bonesetters) are likely to support such an

initiative. These personnel can serve as a link between the health system and the

community in which they work. This link is also a point at which to establish an

intersectoral team of all stakeholders such as livestock and veterinary technicians who

have close working interest with the community (Duba et al., 2001).

Figure 5: Good Practice in Health Service Provision - External Agency

 Combined complementary mobile and static health service provision may have greater impact on health of pastoralists.  The combined training of community‐based animal and human health workers and traditional birth attendants should be encouraged as they could provide valuable health provision and remain within the community. 

Summary Box: Good Practice in Health Service Provision – External Agency  Joint human and livestock interventions can allow greater access to children within pastoralist communities as well as building up trust between service providers and community. 

Health provision to pastoralists – the UNICEF Experience

Current initiatives in UNICEF programming for women and children in the health and

other sectors suggest that good practice is being implemented, however, this opinion

is based on anecdotal rather than empirical evidence. From a review of activities in

pastoralist communities being carried out by UNICEF in the HoA, it was extremely

difficult to assess the impact (and therefore potential good practice) of these

interventions as there were very few evaluations and thus very few indicators of

impact of these interventions. Impact would then necessarily inform lessons learned

which would feed back into programme design.

One activity which has been evaluated with respect to cost-effectiveness and overall

impact on improving the health of children is Child Health Days in Somalia. More

details of this activity and the results of its evaluation follow.

Child Health Days in Somalia (CHD)

Child Health Days in Somalia were originally organized as twice yearly outreach

events in response to the high under five mortality rates, the extended conflict and the

collapse of health systems in the country. This activity was viewed as a successful

means of delivering key child survival mechanisms and initially centred around

administering polio vaccines and Vitamin A to a large number of children at one time.

Subsequently more child survival interventions were added, including measles,

Diptheria-Typhoid-Pertussis (DTP) and Tetanus Toxoid (TT) vaccines, provision of

19

deworming and water purification tablets, Oral Rehydration Salts (ORS) and the

opportunity to weigh and measure children to collect data and determine nutritional

status.

A joint WHO/UNICEF evaluation of two rounds of CHDs was carried out to

determine the average cost per beneficiary targeted and per beneficiary accessible by

each intervention, and the economies of scale and scope, the cost-effectiveness of the

CHDs and whether any additional cost-effectiveness could be achieved by using a

pentavalent DTP-Hib-HepB vaccine rather than a simple DTP vaccine.

The indicator used to evaluate impact of child survival activities of CHDs was

Disability-adjusted life years (DALYs), which are a measure of potential years of life

lost due to early death and potential years of productive life lost due to disability. This

analysis only includes the mortality impact and does not also include morbidity

impact. The overall cost of the intervention and the number of beneficiaries reached

was then analysed to determine the unit cost per beneficiary. Further analysis also

included the potential DALYs averted for the use of a pentavalent vaccine and cost-

benefit analysis of a more expensive vaccine.

The evaluation concluded that using CHDs as a platform for delivery of child survival

interventions in a conflict setting, despite the high operational costs, provides

excellent value for money; less than $1/intervention/beneficiary targeted. Further,

when analysed alongside other health sector “best buys” in sub-Saharan Africa such

as malaria interventions and HIV/AIDS activities, CHDs compared favourably. It was

further determined that the use of a pentavalent vaccine for both rounds of CHDs

could have had a greater impact on child mortality than use of simple DTP vaccine.,

despite the additional cost.

The following example of good practice has been included, but with the caveat that it

does not fully exemplify good practice as it has been evaluated with respect to its

achievement of target or process indicators, but not with respect to impact indicators.

In order to evaluate the impact of the distribution of mosquito nets on the incidence

and frequency of malaria and the overall improvement of child health and child

20

survival statistics in Karamoja, a further impact evaluation needs to be carried out,

preferably over a long period of time.

Long Lasting Insecticide Treated Nets (LLIN) in Karamoja

In June 2008, UNICEF in partnership with the Ministry of Health and the District

Local Governments in Karamoja sub-region embarked on a Long Lasting Insecticide

Treated Net (LLIN)1 distribution exercise. The aim was to scale-up net coverage by

providing two LLINs per household in all districts in Karamoja as well carry out an

intensive BCC campaign to ensure their retention and use. The distribution exercise

took place in October and November 2008. The overall goal of the LLIN campaign

was to contribute to the reduction of malaria related morbidity and mortality in the

Karamoja sub-region by ensuring 80% of households have at least two nets,

increasing the percentage of children under five sleeping under an ITN from 7.2% to

60% and increasing the percentage of pregnant women sleeping under an ITN from

2.7% to 60%.

An evaluation survey was then carried out of which the specific objectives were:

Establish performance against distribution coverage and use targets

Determine the factors/issues that affect retention and use of mosquito nets

Comment on the effectiveness of the BCC campaign and make

recommendations for its improvement

Make recommendations on how to improve net retention and use and suggest

appropriate strategies to facilitate this.

The results of the evaluation concluded that although the distribution campaign did

not reach the performance targets originally set out, improved coverage and use of

ITNs by the target groups was achieved. Recommendations following the evaluation

also included lessons learnt on the distribution of BCC materials, the time lines

surrounding implementation of different types of activities and the establishing of

1 There is a difference between ITNs and LLINs. ITNs are pretreated nets obtained in the last 12 months or non-pretreated nets

which have subsequently been soaked with insecticide at any time. ITNs are not long lasting and therefore require re-treatment

after 6-12 months. LLINs are manufactured with insecticide embedded (factory treated nets). They are long lasting and do not

require any re-treatment. All LLINs are ITNs and not all ITNs are LLINs. The LLINs referred to in this report are those which

were given out by UNICEF during the campaign distribution. The prescribed distribution targets used the term ‘ITNs’.

21

baseline data prior to onset of any intervention. All of these can prove useful in

determining an improved distribution of mosquito nets for greater coverage and

potential for achieving targets. What the evaluation did not establish was the cost-

effectiveness of the intervention and the impact of the distribution of mosquito nets on

improved health and reduction in malaria of the target population.

Some of the examples of initiatives currently being carried out such as the Mobile

Health Teams in Ethiopia which are supported by UNICEF and the Government of

Ethiopia are providing good anecdotal evidence as to their effectiveness in providing

health services to remote populations. What is needed is an evaluation of these

activities, particularly with respect to the cost-effectiveness of mobile activities and

the impact in improvement of core health indicators within the population.

Figure 6: Good Practice in Health Provision - UNICEF

 Child Health Days in Somalia have been proven to be both cost‐effective and show impact in averting DALYs. Use of a pentavalent vaccine rather than a simple vaccine would further improve child survival status.  Initiatives such as LLINs in Karamoja and the success of Mobile Health Teams in Ethiopia have yet to evaluated. 

Summary Box: Good Practice in Health Service Provision – UNICEF 

Food Security and Livelihoods

Food aid has been widely distributed in response to the cycle of droughts that are an

inevitable part of livelihood patterns in pastoral areas. This distribution has been so

prevalent and become so entrenched that it now forms part of the formal social

assistance packages that many pastoralists rely on as a regular food source. Food aid

has been provided in North East Kenya since the drought of 1996–97, regardless of

the pastoral systems’ productivity during those years. Studies examining livelihood

strategies in pastoral areas of north-east Kenya (Save the Children UK, 2007) have

found that food aid makes an important contribution to household food consumption

for all poor and middle-income households in pastoral areas in recent ‘normal’ years

22

of production. Even better-off households in some areas receive food relief in a

‘normal’ year – pointing to excessive and poorly targeted food aid interventions.

Formal emergency responses and development instruments have for too long focused

on food-based social assistance packages to pastoralist communities with the

assumption that it will reduce vulnerabilities. It has been argued that this continued

delivery of inappropriate emergency assistance has not strengthened pastoralists’

resilience to shocks – and indeed has worked to undermine local coping strategies.

Current emergency responses are designed primarily to save lives and often have the

perverse effect of encouraging people to remain in places that cannot sustain them;

decades of almost continuous food aid, water trucking and other last-resort emergency

inputs have led to the mushrooming of settlements, associated degradation of the local

environment and decreased access to dry season pastures (Chinogwenya & Hobson,

2009). Food aid should be a safety net of last resort but has become the safety net of

first (and in some cases only) resort .

For the purposes of this review paper, Food Security initiatives focusing on

livelihoods’ contributions have been reviewed and not nutrition programmes which

focus on supplementary feeding as the main strategy for improving nutritional status.

Food security programmes represent a more holistic, livelihoods analysis approach

and look to secure the longer term nutritional status of the population, rather than

those focusing on supplementary feeding, which although saving lives, should only be

used in emergency situations. It can be argued that used in isolation, supplementary

feeding programmes do little more than allow pastoralists weather the lack of food

within their communities and when discharged, patients return to the same conditions

from which they came, with little improvement in their ability to provide food for

themselves as their livelihood status (income and the ability to buy food, livestock

able to supplement their diet with milk and other livestock products) has not changed.

23

External Agency Experience in Food Security

Pastoralist Areas Coordination Analysis and Policy Support (PACAPS) Early Warning/Early Response (EW/ER) Mandera Triangle strategy for pastoral communities

The Enhanced Livelihoods in the Mandera Triangle (ELMT) is the operational arm of

the Regional Enhanced Livelihoods in Pastoralist Areas (RELPA) initiative funded by

USAID. The program specifically supports results to: (i) protect livestock-based

livelihoods in emergencies; (ii) enhance livelihoods through improved livestock

production, health and marketing; (iii) enhance natural resource management; (iv)

strengthen alternative livelihood strategies; (v) strengthen capacity of customary

institutions in peace building, civil governance and conflict mitigation; and (vi)

strengthen the pastoralist area “voice” in dryland policy formulation and

implementation (Nicholson & Desta, 2010). With respect to enhancing livestock

livelihoods, the programme focuses on improving livelihood security for pastoralist

populations by enhancing coordination of regional partners to support timely and

harmonised livelihoods-based cross-border relief and resilience building

interventions. These include improving regional EW/ER analytical approaches with

better coordination of information and data which can add value to existing national

and local EW information bases.

Crucial to this is application of a livelihoods framework which uses as its base the

Household Economy Analysis to disaggregate the population by where they live

(geographical zone), wealth and asset classification and their seasonal access to food,

income and change in expenditure patterns. This livelihoods analysis also employs the

use of a seasonal calendar which map predictable weather patterns, livestock

condition and reproduction, livestock products and prices and the prices and

availability of other commodities such as grain. The calendar can then be reproduced

with respect to a change in weather variables such as the failure of rains and the

impact this has on the other livelihood variables to suggest entry points for not only

response activities but for capacity building and resilience activities within the

community to offset the more disasterous effects of a drought-related famine.

24

If an adequate early warning system is in place and sufficient knowledge regarding

pastoralist seasonal production systems exists, strategies sucha as the protection of

core breeding herds for recovery, the timely selling of livestock with regard to their

condition and market prices and the monitoring of grain prices for stocking can be put

into practice early enough for the population to cope with drought. The timeline for

implementation of interventions such as fodder supply, veterinary health care, water

provision and the selling of livestock are not determined by a humanitarian

intervention timetable, but by the pastoralist seasonal calendar, thereby building the

capacity of the community to cope and withstand. Decisions surrounding these types

of interventions must take place well in advance as the time lag from decision taken to

implementation of activities can be instrumental in excerbating vulnerability. It is for

this reason that the seasonal calendar plays a crucial role as events are known and

predictable, based on early warning systems.

It is important also that any pastoralist livelihoods interventions designed to build

resilience and capacity are multi-sectoral. With the use of a seasonal calendar,

opportunities for WASH and nutrition interventions also become clear and can

contribute to better prepared communities. The optimal point for targeting

interventions is dependent largely on accurate regional data, which sometimes differs

from national available data in its detail and must be reviewed frequently.

An evaluation of the ELMT programme activities was carried out in January 2010.

This evaluation revealed that although the programme was somewhat successful in

protecting livelihoods in the Mandera Triangle region through its interventions, the

number of those affected by the programme was far too few. The evaluation stated

that key challenges to the implementation of activities were in addition to poor rains

and rising insecurity in the program areas making operational activities difficult, the

coordination of partnerships between the various institutions and governments proved

hard to achieve, the unrealistically short time frame (2 years), high staff turnover and

donor conditions often hampered project achievements more. It did state, however,

that given a more realistic time frame and established networks and coordination, the

basic tenets of programme operation could prove valuable in protecting vulnerable

livelihoods (Nicholson & Desta, 2010).

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Save the Children’s Africa Regional Pastoral Initiative - Pastoral Health and Nutrition Initiative (PHNI): Milk Matters

Save the Children USA and UK (SCUS/SCUK) and the Feinstein International Center

(FIC) at Tufts University joined efforts on a venture called Milk Matters to explore

interventions related to one of the most important component of children’s diets:

human and animal milk. This initiative included a review of the relevant literature and

studies that were carried out in the pastoralist population of Ethiopia.

The review examined the literature in major databases to accumulate knowledge and

experience on improving the health and nutritional status of children in pastoral

settings. Although most of the agencies involved were based in Addis Ababa and

therefore more relevant to Ethiopian pastoralist populations, the information and

learning can be of value to other HoA populations, given that the context does not

differ substantially between popoulations. The aims of Milk Matters were:

• To identify interventions that lead to an enhanced supply of animal and breast milk

for children in pastoral communities across seasons and wealth groups, thereby

leading to improved nutritional status;

• To support implementation of effective interventions at a large-scale;

• To advocate for policies that promote healthy and well-nourished children in

pastoral communities and influence the implementation of the Government’s national

Nutrition Strategy accordingly;

• To communicate the results to a broad audience of pastoral communities,

government institutions, researchers and practitioners.

One of the activities that took place under the Milk Matters initiative was a study

which aimed to ask pastoralist women and men in the Shinile and Liben Zones of

Somali Region what they think about the important causes of child malnutrition, links

between child nutritional status and milk supply, and ‘best bet’ interventions for

addressing malnutrition in their communities. It used recognized participatory

methods such as matrix scoring, seasonal calendars and ranking to produce detailed

information on how young children were fed, the reasons behind the choice of foods

used, and on seasonal trends and relationships.

26

The results of this study were as follows and much of the information and data

gathered should be used to inform food security programmes in pastoralist areas.

1. The demand and perceived benefit of animal milk for young children is high

and generally much higher than that for cereals. The milk of camels and goats is

held in particularly high regard; linked to these animals’ ability to produce milk

through the dry season, the perceived health benefits of the milk and the taste.

2. The large contribution that animal milk makes to the dietary intake of young

children in the study communities is startling. When milk is available it is

added to most complementary foods in both Liben and Shinile, and during

a normal wet season the average milk intake of a one year old provides

about two‐thirds of the mean energy required and 100% of the protein

required by a child of this age.

3. Season plays a crucial role in milk supply and by the end of a ‘normal’ year

milk intake of young children has reduced by more than 70%. In a drought year

this reduction in intake was far more pronounced. By the end of a drought year

milk intake in young children had fallen to negligible amounts in both areas.

4. When milk is in short supply it is replaced, in the most part, by an increase in

grain consumption, and by the end of a long dry season or drought year the

grain is cooked and consumed with little else but water. Such a severe reduction

in milk intake has a serious impact on dietary quality by reducing the amount of

high quality protein, fatty acids and micronutrients that young children

consume.

5. Study participants perceived a direct and important association between reduced

milk intake and weight loss among their young children. The ‘the suffering due

to lack of milk’ is known by local people as the pre‐cursor to malnutrition as

they define it. In future it will be important to examine the implications of this

seasonal availability of milk for patterns of nutritional status as defined by

international indicators and how this overlaps with pastoralists own definitions

of malnutrition in this context.

6. In the opinion of the pastoralists that participated in this study, the most

effective way to improve availability and access to milk for young children

is clear; that is through the maintenance of the health and nutritional

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7. Many of the programs that might fall into the broad categories discussed are not

new, and there is already some evidence that they can lead to real improvement

in livestock health and milk production. There is far less evidence however of

any impact of such interventions on the nutritional status of children, and it is

here that more work is needed.

8. Given the issue of milk access for young children during late dry season and

drought, especially access to camel milk, it is possible that the benefits of

interventions that aim to improve child nutrition such as veterinary care for

camels or camel restocking would not be fully captured in terms of milk

consumption by children at critical times. This points to a need to review these

projects and look more carefully at ways to ensure that milk reaches young

children when they need it most (Sadler & Catley, 2009).

As the study indicates, improvements in the health of animals will have direct bearing

on improvement on the nutritional status of the population, particularly that of

children. Interventions targeted at livestock with respect to a seasonal calendar will

have an enormous impact on the maintenance of adequate milk production and

enhanced nutrition.

Disaster Risk Reduction in Mitigation of Food Insecurity in Ethiopia

In the past, pastoralist area development had received relatively little attention from

policy makers, and pastoral peoples were largely economically, socially, and

politically marginalized. Key development issues in these areas include: (i) land

tenure security for grazing land and encroachment by sedentary populations as well as

28

large scale development schemes, poor access to public services, especially health and

education, (iii) restrictive livestock marketing policy and poorly developed support

infrastructure and services, (iv) vulnerability to drought shocks, (v) environmental

degradation, in particular of rangelands; and (vi) violent conflicts related to natural

resource management. The severity of their socio-economic situation, in particular

regarding food security, prompted the Government of Ethiopia (GoE) to intensify its

search for sustainable development strategies in these areas from 2002 onwards.

The GoE’s current vision for addressing development in pastoral areas is explicitly

addressed in a separate section of its national Poverty Reduction Strategy Paper

(PRSP) of September 2006: “Ethiopia: Building on Progress – A Plan for Accelerated

and Sustained Development to End Poverty” (PASDEP). The section on “Pastoralist

Livelihoods and Development” acknowledges the previous marginalization of

pastoral populations and recognizes that pastoralist populations are among the poorest

of the poor in Ethiopia. It proposes a range of livelihoods and service delivery

interventions to address this situation.

In 2003, the GoE initiated the Pastoral Community Development Program (PCDP), a

fifteen-year Program designed to empower communities, district (woreda) and

regional governments to better manage local development in pastoral areas, with the

aim of increasing, stabilizing, and diversifying incomes, improving infrastructure, and

increasing access to public services. The PCDP seeks improve in a sustainable

manner the livelihoods of pastoralists living in the arid and semi-arid Ethiopian

rangelands. The Program works through a community-based development planning

process linked to a Community Investment Fund (CIF), which flows through local

government. PCDP also supports a participatory disaster management program to

reduce the risk of pastoral communities to drought and other natural threats to

livelihoods. These efforts are reinforced through policy research and applied technical

research into dryland agriculture and natural resource management.

This approach to participatory community-based development has been initiated

successfully in 32 pastoral woredas in four regions during Phase I of the PCDP. In

view of the long-term nature of supporting community empowerment, local

government strengthening, as well as policy reform for these remote areas, the World

29

Bank initiated a 15-year, three-phase Adaptable Program Lending (APL). The

International Fund for Agriculture Development (IFAD) has co-financed the first

phase of the Program.

While significant progress has been made in the first phase of the PCDP, much

remains to be done to expand the project geographically, and to consolidate

community empowerment, local government strengthening and disaster risk

management efforts initiated thus far in 32 pastoral woredas.

Figure 7: Good Practice in Food Security and Livelihoods Interventions - External Agency

 Government of Ethiopia’s Pastoral Community Development Program seeks to empower communities, district (woreda) and regional governments to better manage local development in pastoral areas, with the aim of increasing, stabilizing, and diversifying incomes, improving infrastructure, and increasing access to public services. The PCDP seeks improve in a sustainable manner the livelihoods of pastoralists living in the arid and semi‐arid Ethiopian rangelands. 

Summary Box: Good Practice in Food Security and Livelihoods Interventions – External Agency  Use of tools such as Livelihoods Analysis Frameworks, Household Economy Analysis and the seasonal calendar, including mapping patterns of income and consumption can greatly assist in timely interventions which are implemented before the crisis begins and not in response to an emergency – DRR programming  Interventions that ensure a priority in animal interventions at times throughout the year with fodder and water provision can greatly improve child nutrition by sustained milk production – Milk Matters 

30

Education

External Agency Experience

Tent Schools in Iran

The tent school system in south and south-west of Iran among Qashqa’i has now

operated for over 50 years, and has successfully educated several generations of

nomadic children. There are approximately a quarter of a million Qashqa’i in Iran

who migrate between summer and winter pastures seasonally but while in either

pasture, move very little.

The tent schools were started by Mohammed Bahmanbaigi in the 1950s who was

determined to preserve the nomadic way of life for the Qashqa’i people and saw

schools and education as a way of supporting this strategy. He first drafted a literacy

plan to teach the Qashqa’i basic literacy skills. This was followed by the

establishment of a Teacher Training School, an Elementary School, a Middle School a

High School, a general Technical School and eventually, a Carpet Weaving School.

The schools relied upon teachers from a nomadic pastoral background who were

trained, equipped with a white schooling tent and teaching materials who joined a

group of pastoral households. There was an almost equal enrollment of girls and boys

and after 5 years of elementary education, graduates of this program could continue at

a boarding school.

The Qashqa’i benefited tremendously from formal education. Not least, they benefited

from being able to participate in modern Iranian society; some became state officials

with government jobs, they learnt about their civil rights and how to defend

themselves in the modern legal system, and even while seeking to preserve their own

cultural identity, established a sense of nationalism.

In countries where pastoralism is viewed as a respectable way of life such as in Iran or

Mongolia and in programmes which are supported by indigenous teachers paid by the

government, interventions such as tent schools have been successful. In addition,

when compared to the migratory movements of pastoralists in the Horn of Africa, this

society generally only moved twice a year, thus facilitating the establishment of

31

almost sedentary schools, albeit in areas which were very remote. Although many

people benefited from this educational system, one of the concerns that has been

voiced by former scholars is that, like their pastoralist counterparts in the Horn of

Africa, they felt they sacrificed some of their opportunity to amass knowledge on

indigenous herd management skills and animal husbandry and care by being in school

(Shabazi, 2006).

Distance Learning for Women in the Gobi Desert

Open and distance education (ODE) was introduced into Mongolia through donor-

funded projects and international consultants for the first time in the 1990s as a

response to economic crisis and subsequent social consequences. A non-formal

education project was started for 15,000 nomadic women (anticipating government

policy for targeted support for women through the National Plan of Action for the

Advancement of Women). Literacy levels were high due to education provided during

the socialist period in Mongolia and the targeted areas for educations were livestock

management and processing of animal products; family care; literacy support;

survival skills; income-generation using locally available raw materials; and basic

business knowledge for a new market economy (Robinson, 1999).

The project relied upon dissemination of information and lessons broadcast from the

central government owned radio station in Ulaanbaatar and three provincial radio

studios which in turn reached six provinces. Weekly radio programmes were

broadcast nationally and supplementary materials were produced at the local level.

Printed booklets were produced including topics such as family planning. A teacher-

training programme was developed and local tutors (‘visiting teachers’) were trained -

each responsible for about 15 learners. These teachers travelled around mainly by

horse, camel or occasionally by motor-bike. Learner support was provided through

visiting teachers, local meetings and at district centres, there was a set of project

booklets and other learning materials, information leaflets, posters, and craft

exhibitions in district centres.

The radio programmes were generally well received and attracted a large audience.

These were supplemented by group learning which provided an opportunity for

32

33

tutoring and demonstration, and the exchange of ideas and news. The project also

flourished at local level and is an example of implementing a decentralised education

programme in a country which was accustomed to highly centralised educational

provision and control. Radio proved very effective in providing topical programmes

and in reaching large numbers of learners rapidly though economic problems limited

access. Print production was less speedy which can be attributed to the fact that many

producers were novices, with little access to computer technology.

Some of the limitations of the project were that the quality of material varied widely

and the delivery of the printed materials was often delayed. In addition, there was

sometimes a lack of coordination amongst those responsible for the radio broadcasts

and those responsible for the printed materials. In addition, although the project was

intended to reach women and cater specifically to their needs, some of the materials

were written by urban men who lacked the necessary skills to impart the knowledge

(Robinson, 1999).

One of the major failings of the project was that it proved largely unsustainable by the

state following the conclusion of donor funding. Some local initiatives supported by

committed individuals with sufficient resources within the specific communities were

able to continue but the major components of the programme finished.

‘The unusually long experience of Mongolia regarding education for pastoralists

suggests that education can be practically organized for pastoralists. The more

pertinent question is whether such success is possible in a market economy where

other values strongly prevail’ (Demberel & Penn, 2006), (or in a developing economy

where other priorities take precedence). Nonetheless, if radios are made available to

pastoralists and are easily and cheaply maintained, activities such as these have the

potential to take place in pastoralist societies in the Horn of Africa. A more detailed

proposal of such a programme in Kenya can be found in Towards Education for

Nomads: Community Perspectives in Kenya, by (Birch et al., 2010).

Figure 8: Good Practice in Provision of Education - External Agency

Summary Box: Good Practice in Provision of Education to Nomadic People  Tent schools in Iran have proven to be successful in providing education to nomadic people. One of the differences between these communities and those within the HoA are that they migrate in predictable patterns, usually twice a year, allowing the tent schools to become semi‐permanent.  Evidence has shown that education programmes for pastoralist societies are successful when pastoralism is accepted and endorsed by respective governments as a viable way of life. In addition, the content of the curriculum and the perception of its relevance to pastoralists’ way of life and value systems is crucial to ensuring prioritization by nomads.  Distance education programmes using radio broadcasts were successful in reaching women in Mongolia. Its sustainability, however was largely dependent on donor funding and the major components finished once funding stopped. This type of initiative could be replicated on a decentralized level in the HoA, provided that radios were cheap to operate and maintain and infrastructure was sufficient. 

Education - UNICEF Experience

The examples of education projects that are more discussed following demonstrate

increased access to education for nomadic children and in particular, nomadic girls.

What is lacking, however, is any evaluation of baseline figures against actual children

attending and qualitative analysis of pastoralist perceptions of relevance of curricula

and impact of education on core indicators.

North-eastern Province Girls Scholarship Education Program in

Kenya

The NEP girls’ scholarship program has had the single most significant positive

effects on girls’ education in NEP’s history and perhaps the indirect benefits might

never be measured. As an exit strategy and ensuring sustainability of program in

future, UNICEF in collaboration with MOE and Ministry of State for the

Development of Northern Kenya and Other Arid lands (MDNK OAL) is working on

the establishment of a quasi-government “Northern Kenya Education Trust- NoKET’

- to address both secondary and tertiary education for girls from ASAL districts.

NoKET has a Board of Trustees drawn from leading Kenyan professionals,

marathoners; conservationists, politicians, educationists, all of whom come from or

work with nomadic communities. This Trust will open up the program for more

beneficiaries from larger nomadic communities as well as support tertiary education.

34

In order to institutionalize the affirmative action exposing nomadic girls to very good

performing schools, a tripartite MoU has been signed between the Ministry of

Education, MDNK OAL and NoKET. This MoU ensures 200 instead of 60 slots for

nomadic girls in good performing national and provincial schools to girls from 10

nomadic counties nationally and increases university admission for more females

from nomadic communities.

Flexible Approach to Basic Education (FABE) in partnership with

Africa Educational Trust (AET), Horn Relief and Save the Children

in Puntland

FABE is a flexible and sustainable system for delivering basic education to children

in nomadic and pastoral areas, which uses local NGOs and builds capacities within

the communities. Representatives from 60 nomadic and pastoral communities across

Puntland met with regional education officers and discussed the needs of the children

within regarding education and have advocated for a suitable programme which deals

with imparting skills particular to their communities. The Ministries of Education

have improved capacity to meet the needs of the subject communities. Appropriate

materials in numeracy and literacy have been developed which are culturally

appropriate. Exams for literacy, numeracy and life skills suitable for pastoralists have

been developed in conjunction with the National Examination Boards and

administered in 50 communities. Baseline studies and community needs assessments

have been undertaken by local partners in conjunction with local communities along

with regular meetings with community elders or village committees to ascertain

needs, concerns and opportunities, the results of which feed back into the steering

committee. 3000 children have completed 12 months of Level One Basic Education in

literacy, numeracy and life skills using appropriate curriculum developed with

communities’ input.

Pastoral Youth Leadership in Puntland in partnership with Horn

Relief

Building on the work that Horn Relief has been doing in the disputed region of

Sanaag in the north, UNICEF has been supporting the Pastoral Youth Leadership

35

(PYL) project. The project reaches out to older nomadic youth in five pastoralist

communities by providing a basic education through a curriculum that has been

locally developed. The project focuses on nomadic/pastoralist youth aged between

14–25 years who desire to pursue education but have never had an opportunity due to

lack of money, educational opportunities or other underlying inhibitions. This work

has directly benefited 1,429 learners (851 females).

The main objective of the PYL curriculum that was revised under the leadership of

the Puntland Ministry of Education is to enable the participants to create awareness

among community members in the areas of human health, animal husbandry, natural

resource management and leadership/governance. Apart from PYL centres (454

learners) already using the PYL curriculum materials directly, there are six primary

schools in the region that benefit from the PYL curriculum materials, through

integration and infusion, to complement the Puntland National Primary School

Curriculum (NPSC). The PYL curriculum therefore provides relevant reference

material which can be used to enrich the official and harmonized curriculum used in

formal and non-formal schools in agro-pastoral and pastoral nomadic communities

throughout Puntland.

The projects assist the participants in training in order to improve livelihoods through

capacity building, transitioning into formal education and joining technical/vocational

training institutes for further education.

The project also came up with a centralized and moderated examination that leads to

certification by the Ministry of Education. There were 158 candidates (134 females)

from six PYL centres who registered for the first examination. Currently there are 83

PYL graduates that have transited to primary schools and formal education. Five PYL

graduates who had moved up to the secondary school had taken their national form

four examinations with four scoring grade C and one scoring grade B. This shows that

the PYL curriculum is relevant to the needs of the learners and that it does offer the

pastoralist children an avenue to continue in the formal system and to the higher

levels of education.

36

In addition, the PYL project promotes participatory action research method and social

mobilization as a means of addressing issues that are relevant to the nomadic lifestyle.

The key event for this in remote nomadic areas is through the Camel Caravan Pastoral

Community Survey that has been organized in two parts. In the first part youth from

PYL lived and moved with the pastoralists on a camel for a period of 1 month putting

in practice the skills and knowledge acquired from PYL project in the areas of

leadership, human health, animal husbandry and natural resource management. They

also shared knowledge and skills between the PYL students or graduates and the

pastoralists and organized focus group discussions. The Camel Caravan participants

also took the opportunity to sensitise parents and leaders and encourage them to take

advantage of education services available in agro-pastoral communities for their

children when they pass time during the extreme drought periods. In the 2nd part of the

Camel Caravan, complementary information was gathered through administering a

small 10 day household survey on PYL thematic areas.

One of the key recommendations of the exercise and the Camel Caravan report is that

broader baseline data is needed on the pastoralist communities and their needs and

that interventions are needed to improved sustainable livelihood options for

pastoralists/nomadic people. It is also clear that more coordinated collaboration

among sector stakeholders is necessary to support education of Somali nomadic

pastoralist children.

Horn Relief is ensuring the sustainability of this project through engaging Community

Education Committees, community members and Community Based Organizations

and eventually transferring the management of PYL classes to them in 2011.

Alternative Basic Education Centres in Karamoja, Uganda (ABEK)

UNICEF and the Government of Uganda have been working together since 1998 to

provide an alternative form of education for the children of Karamoja. From 2005

data there was a total population of 303,694 children of school going age in the then

three districts of Kotido, Moroto, and Nakapiripirit. Out of this number only 90,317 or

29.73% were attending school.

37

UNICEF, to better focus its work and provide support to district local governments in

Karamoja, commissioned a comprehensive study (Kariuki, 2006) in 2006 of pre-

primary and primary education in Karamoja. This study was expected to provide a

deeper understanding of issues affecting educational participation in Karamoja, a

detailed review of current interventions including those in related sectors and provide

an updated and substantive baseline survey and an analysis of the status of education

in Karamoja, through a consultative process.

The study found the following factors affecting participation in education in

Karamoja:

Pastoralist indigenous culture, lifestyle and economy (Demand side)

There is a high demand for children’s household labour in caring for livestock

where they have clearly defined roles.

Education curriculum may conflict with pastoralist lifestyle due to the

inflexibility of school timetable and calendar. Consequently there is high

absenteeism and irregular attendance.

The community may not recognize the long-term value of education as they

struggle for daily survival. Many of the children, especially girls, drop out.

Lack of access to both formal and non-formal education (Supply Side)

Lack of schools and long distances for children, in some parts of Karamoja

ABEK centres not available in all sub-counties

Many schools do not have the full range of classes

Inadequate number of classrooms in some schools

Quality – Formal Education

Inadequate teacher numbers, especially trained teachers

Low teacher morale, owing to insecurity and poor support system

High rate of absenteeism among teachers and pupils

Insufficient teaching/learning materials

Poor school management and supervision

Quality - ABEK

Facilitator absenteeism, mainly owing to distances and irregular payment of

salaries

Number of hours per day, facilitator-student contact time

38

Inadequate monitoring and supervision of instruction and learning outcomes

Consistency and follow up of completion of modules

Learning Outcomes

Poor learning outcomes for children and community

Relevance and use of the skills acquired in school in the community

Key Challenges

Insecurity: affects enrolment and attendance by both teachers and pupils and

contributes to increasing in poverty and makes it difficult to attract staff to work

in the area.

Poverty and inability to meet education costs and the opportunity costs of sending

children to school.

Food insecurity, affecting enrolments and attendance.

The study also concluded that addressing the challenges facing education in Karamoja

will require more than education sector interventions. The nature and extent of the

problems facing education are diverse and intricately interlinked with challenges that

confront development in the sub-region and need a multi-sectoral and holistic

approach. Further, the physical, social and political marginalisation must be dealt

with.

Figure 9: Good Practice in Provision of Education - UNICEF

39

Summary Box: Good Practice in Provision of Education to Nomadic People ‐ UNICEF  The Pastoralist Youth Leadership (PYL) programme in Puntland has been successful in providing alternative education to older nomadic youth who have missed out for various reasons. The aim of the programme is to teach curriculum that is relevant for these communities; human health, animal husbandry, natural resource management and leadership/governance. Over half the beneficiaries so far have been girls and many have transitioned to further formal schooling.  Key challenges facing children taking part in Alternative Basic Education in Karamoja centre around insecurity, which affects enrolment and attendance by both teachers and students, poverty which makes justifying the opportunity cost of lost home labour difficult in favour of school and food insecurity, which affects enrolment and attendance. 

WASH Activities

There is a notable absence of examples of WASH activities taking place for nomadic

people other than the transport of water for people and animals during emergencies

and the provision of Aquatabs during Child Health Days in Somalia. This applies both

to external activities and to UNICEF activities. Within agencies outside UNICEF,

there are interventions ongoing such as the rehabilitation of berkeds in Somalia and

the establishment of fixed water points near Primary schools but it would appear that

not a great deal of investment or analysis has been made in this sector to specifically

target the needs of nomadic populations. This applies both the analysis required to

plan activities and the evaluation of interventions to determine their effectiveness for

ASAL areas.

Most WASH activities carried out by external agencies are implemented under the

auspice of livelihood activities or emergency response. More work needs to be carried

out using the seasonal pastoral calendar as described in the Food Security section of

this paper to implement WASH interventions to build capacity within the population

to increase the ability of livestock to continue to be productive and provide milk and

meat during the dry season.

For UNICEF, cooperation with livestock agencies and others currently engaged in the

mapping of water points and the analysis of usage of these points in the HoA could

lead to more intelligent targeting of interventions and resources. UNICEF is the

global WASH cluster lead agency and should be closely involved in developing good

practice for WASH interventions for populations in ASAL regions. An example of

this type of leadership could be to develop guidelines on water trucking and transport

outside of emergency scenarios. These interventions could greatly increase the ability

of the people of the ASALs to withstand the effect of drought and forestall famine.

40

Figure 10: Good Practice in WASH interventions

Summary Box: Good Practice in WASH Interventions  There is a notable absence of WASH activities for pastoral populations.  Most activities fall under emergency response (water trucking, water vouchers). Guidelines for these emergency situations need to be developed.  Implementation of WASH activities should be strategic and in keeping with livelihoods strategies such as maintenance of condition of livestock to continue milk production and offset potential human nutrition deficits in dry season.  Any interventions in this sector must involve livestock agencies such as FAO and others and take into account a multi‐sectoral perspective. 

Social Protection

Social protection is defined as a basic human right that strengthens the social contract

between the state and its citizens (Ali & Hobson, 2009). Social protection leads to

social development – a cornerstone of economic advancement and political stability.

In the Horn and East Africa, social protection providers fall into two main categories:

informal and formal. Informal providers are communities and external social

networks such as family members, relatives and other social structures outside

pastoral systems. Strong informal social protection networks based on religious, clan

or family affiliations have always played a vital role in pastoral communities, and

protect livelihoods against the chronic shocks inherent in the drylands. However,

these informal support networks are under increasing pressure. Formal providers of

social protection are governments, the private sector, humanitarian organisations and

local and international donors. This group of actors primarily concentrates on

providing assistance and services originally designed for sedentary populations, with

little consideration for the specific needs and vulnerabilities of pastoralists. Social

insurance and equity are practically non-existent.

Experience of External Agencies

A tailored approach to social protection for pastoral communities is required – one

which recognises the context of pastoral livelihoods and views social protection

41

through a livelihoods framework which integrates the four pillars of social protection

(assistance, services, insurance and equity), where equity is paramount at every level

of intervention.

Some of examples of social protection interventions appropriate to pastoralist needs

are livestock insurance, providing business training to explore income diversification

options, providing safety nets such as cash distribution during times of stress and

increasing the ability of pastoralists to be represented in national legislative

frameworks and local bodies such as school and water management committees.

Livestock and Health Insurance

Insurance schemes for livestock health and loss during droughts and dry seasons

could prove valuable in helping pastoralists cope in times of stress and improve the

ability of communities to reduce livestock losses. In order for these to be successful,

however, governments need to be involved in encouraging the private sector to fund

these schemes and ensuring appropriate regulation which does not hinder

implementation.

Some of the examples of types of insurance schemes are those that operate as animal

health protection instruments in cooperation with veterinarians and agro-vets and

ensure the affordability of drugs for animal care. Others could involve a mechanism

for index insurance schemes which incorporate variables such as weather and

livestock mortality. The testing of schemes developed for sedentary livestock keepers

could also be piloted to learn how these might be adapted to nomadic areas.

Training for Income Diversification

Increasing the ability of pastoralists to be less reliant on livestock as the only source

of income could enhance their ability to withstand famine caused by livestock losses

by allowing them to supplement their diets with purchased commodities. Products

such as leather, dried meat and other livestock based goods which can be sold would

improve their ability to purchase and store grain for use in dry seasons. In addition

business training could allow nomadic people to understand market mechanisms

42

better and capitalize on destocking prior to a dry season by selling animals at the best

price possible.

Safety Net and Cash Assistance Programmes

Agencies such as SCUK have worked with pastoralist communities in Ethiopia,

Kenya and Somalia training them in community-based targeting methods which allow

them to identify the poorest and most vulnerable to receive cash transfers or other

emergency aid. There is also work ongoing in the private sector with mechanisms

such as M-pesa and other similar instruments which allow remittances to reach remote

areas. The Ethiopian Pastoralist Safety Net Programme (PSNP) and the Kenyan

Hunger Safety Net Programme (HSNP) also look at ensuring that the most chronically

vulnerable have access to assistance during times of acute vulnerability.

If properly implemented and monitored these types of cash assistance programmes

could allow pastoralists to weather times of stress as a stop-gap method, rather than an

emergency response mechanism which does not contribute to building capacity or

resilience within the community in the longer term.

Figure 11: Good Practice in Social Protection Interventions

43

Summary Box: Good Practice in Social Protection Interventions  Most social protection programmes in ASAL areas currently supported by UNICEF are part of emergency response mechanisms. These include cash transfers for food and vouchers for water.  Social protection programmes form the basis for building resilience and capacity within the community to withstand shocks. These include animal health and livestock insurance index schemes, business and entrepreneurial training for income diversification and better access to markets and some cash and safety net mechanisms which are designed as stop gap measures before the crisis occurs, rather than an emergency response. 

Recommendations The following are recommendations for improving UNICEF’s programming for

pastoralists, focusing on the method of delivery of the intervention, which is particular

to a remote pastoralist context and also on the content of the intervention.

1. Interventions should be implemented within the context of pastoralist

livelihoods. An analysis tool should have been administered prior to the

planning and design of the intervention which looks carefully at the timing of

the activities and ensures a multi-sectoral, multi-agency approach. Ultimately

all interventions should be focused on building resilience and capacity within

the communities to withstand shocks in times of acute vulnerability. Some of

the interventions required will involve a shorter-term DRR approach and

others will be designed for the longer term and be less response-oriented.

2. Dual animal/human interventions particularly with respect to health activities

could improve access to populations. For example, dual animal/human

vaccination campaigns could increase numbers of children reached if

pastoralists perceive additional benefit for their livestock.

3. All interventions must involve close monitoring of activities with the data

acquired being fed back into regional and national systems. Analysis of this

data should feed back into planning and design of subsequent interventions to

continually improve. Evaluations must be routinely carried out involving a

cost-effectiveness and cost/benefit analysis as well as impact analysis against

core sectoral indicators. These evaluations must be widely distributed and

available to improve future programming.

4. UNICEF must also ensure that planning tools such as the UNDAF, CPAP,

Annual Review and Mid-term Review are used to not only reflect pastoralist

requirements in programming, but also reflect monitoring of success of these

strategies.

44

Figure 12: Schematic for Good Practice

45

Good Practice in Programming to Build Capacity & Resilience

Protect Pastoral Assets and Livelihoods

Reduced Risk Focus of Programming

Partnerships with Livelihoods Agencies Regional Advocacy Knowledge Sharing Knowledge Management Multi-sectoral multi-agency

Livelihoods analysis Risk assessments Integrated use of monitoring data – external and internal Impact evaluation Research to inform evidence base

Regional Platform

Education Pilot and field test for best delivery methodology Curricula content relevant to livelihoods – ie., climate change, household economics, livestock husbandry, hygiene education,

Health One Health - Dual livestock/human interventions – opportunities to interact more with community, more monitoring and evaluation Use of CHDs as entry points for multiple interventions

WASH Dual animal/human focus – water provision for both Hygiene education Guidelines for emergency water provision (trucking, vouchers)

Nutrition Interventions which take into account seasonality of livelihoods Dual animal/child interventions

Social Protection Cash transfers for cyclical debt Destocking – use of culled livestock for nutritional supplementation

Dual animal/human interventions in health, nutrition, WASH and social protection increase entry points for implementation and monitoring and increase knowledge management/sharing.

GOOD PRACTICE

Ways to Enhance Better Use of Data

Ways to Acquire Better Data

Better programming

References

Admassie, A. (2002). Allocation of Children's Time Endowment between Schooling and Work in Rural Ethiopia, #44. Bonn: Center for Development Research.

Ali, A. & Hobson, M. (2009). Social Protection in Pastoralist Areas. London: HPG - Overseas Development Institute.

Aliou, S. (1992). What health system for nomadic populations? World Health Forum, 13, pp. 311-314.

AU. (2010). Policy Framework for Pastoralism in Africa: Securing, Protecting and Improving the Lives, Livelihoods and Rights of Pastoralist Communities. Addis Ababa: African Union - Department of Rural Economy and Agriculture.

Bechir, M., Schelling, E., & Wyss, K. (2004). [An innovative approach combining human and animal vaccination campaigns in nomadic settings of Chad: experiences and costs] FRENCH. Medicine Tropicale, 64, pp. 497-502.

Birch, I., Cavanna, S., Abkula, D., & Hujale, D. (2010). Towards Education for Nomads: Community Perspectives in Kenya. London: International Institute for Environment and Development.

Bonfiglioli, A.M. (1990). Promotion humaine et developpement pastorale. N'Djamena, Tchad: Projet National d'Elevage.

Brainard, J. (1986). Differential mortality in Turkana agriculturalists and pastoralists. American Journal of Physical Anthropology, 70, pp. 525-536.

Brenzel, L. & Claquin, P. (1994). Immunization programs and their costs. Social Science and Medicine, 39, pp. 527-536.

Carr-Hill, R. (2006). Educational Services and Nomadic Groups in Djibouti, Eritrea, Ethiopia, Kenya, Tanzania and Uganda. In C. Dyer (Ed.), The Education of Nomadic Peoples: Current Issues, Future Prospects (pp. 35-52). New York, Oxford: Berghahn Books.

Catley, A. (1999). Methods on the Move: A review of veterinary use of participatory approaches and methods focussing on experiences in dryland Africa. London: International Institute for Environment and Development (IIED).

Chabasse, D., Roure, C., ag Rhaly, A., Ranque, P., & Ouilici, M. (1985). The health of nomads and semi-nomads of the Malian Gourma; an epidemiological approach. In A.G. Hill (Ed.), Population, Health and Nutrition in the Sahel: Issues in the Welfare of Selected West African Communities. London, Boston, Melbourne, Henley: Kegan Paul International.

Chinogwenya, W. & Hobson, M. (2009). Getting it right: Understanding livelihoods to reduce the vulnerability of pastoral communities. London: Overseas Development Institute.

COMESA. (2009). COMESA Policy Framework for Food Security in Pastoralist Areas.

de Waal, A. (1991). Evil Days: 30 Years of War and Famine in Ethiopia. New York: Human Rights Watch.

Delgado, C., Rosengrant, M., Steinfeld, H., Ehui, S., & Courbois, C. (1999). Livestock to 2020 - The next food revolution, Discussion Paper #28. Washington, DC: International Food Policy Research Institute.

46

Demberel & Penn, H. (2006). Education and Pastoralism. In C. Dyer (Ed.), The Education of Nomadic Peoples: Current Issues, Future Prospects (pp. 193-211). New York, Oxford: Berghahn Books.

Duba, H.H., Mur-Veeman, I.M., & van Raak, A. (2001). Pastoral Health Care in Kenya. International Journal of Integrated Care, 1, pp. 1-12.

FARM-Africa. (2002). The Mobile Outreach Approach: best practices from FARM-Africa's Pastoralist Development Project in Kenya. FARM-Africa.

Kariuki, M.R.W. (2006). Unearthing the Pen: Contradictions, Challenges and Opportunities for Education in Karamoja - A study commissioned by UNICEF and MoES.

King, B. (2000). Do mobile clinics work? Health Action, pp. 14. Korwa, G.A. (1993). Kenyan Foreign Policy Behavior Towards Somalia, 1963-1983.

London: University Press of America. Kratli, S. & Dyer, C. (2006). Education and Development for Nomads: the Issues and

the Evidence. In C. Dyer (Ed.), The Education of Nomadic Peoples: Current Issues, Future Prospects. New York, Oxford: Berghahn Books.

Lewis, I.M. (1994). Peoples of the Horn of Africa: Somali, Afar and Saho. London: HAAN.

Little, P., McPeak, J., Barrett, C., & Kristjanson, P. (2006). Challenging Stereotypes: The Multiple Dimensionsof Poverty in Pastoral East Africa.

Loutan, L. (1989). Les problemes de sante dans les zones nomades. In A. Rougement & J. Brunet-Jailly (Eds.), Planifier, gerer, evaluer las sante en pays tropicaux (pp. 219-253). Paris: Doin Editeurs.

Loutan, L. & Paillard, S. (1992). Measles in a West African nomadic community. Geneva: WHO.

Munch, A.K. (2007). Im Schatten der Zelte. Bern: Institut fur Islamwissenschaften, Universitat Bern.

Nicholson, N. & Desta, S. (2010). Final Evaluation of the Enhanced Livelihoods in the Mandera Triangle (ELMT) and Enhanced Livelihoods in Southern Ethiopia (ELSE) Program 2007-2009. CARE, Save the Children, Veterinaires Sans Frontieres - Suisse.

Oxfam GB. (2009). Demographic trends, settlement patterns and service provision in pastoralism: transformation and opportunity. London: Overseas Development Institute.

PCI. (2007). Risk Taking for a Living: Trade and Marketing in Somali Region, Ethiopia.

Pratt, D., Le Gall, F., & De Haan, C. (1997). Investing in Pastoralism: Sustainable Natural Resource Use in Arid Africa and the Middle East. Washington, D C: The World Bank.

Reidy, E. (2010). Better health for herders: Reducing the marginalisation of pastoralists from effective health care. Nairobi.

Reist, S., Hintermann, F., & Sommer, R. (2007). The Livestock Revolution: An Opportunity for Poor Farmers? Focus No 1/07. Zollikofen, Bern, Switzerland.

Robinson, B. (1999). Open and Distance Learning in the Gobi Desert: Non Formal Education for Nomadic Women. Distance Learning, 20, pp. 180-204.

Sadler, K. & Catley, A. (2009). Milk Matters: the role and value of milk in the diets of Somali pastoralist children in Liben and Shinile, Ethiopia. Addis Ababa: Feinstein International Center, Tufts University and Save the Children.

47

48

Schelling, E., Bechir, M., Ahmed, M.A., Wyss, K., Randolph, T.F., & Zinsstag, J. (2007). Human and animal vaccination delivery to remote nomadic families, Chad. Emerging Infectious Diseases, 13, pp. 373-379.

Schelling, E., Diguimbaye, C., Daoud, S., Nicolet, J., Boerlin, P., & Tanner, M. (2003). Brucellosis and Q-fever seroprevalences of nomadic pastoralists and their livestock in Chad. Preventive Veterinary Medicine, 61, pp. 279-293.

Schelling, E., Wiebel, D., & Bonfoh, B. (2008a). Learning from the delivery of social services to pastoralists: elements of good practice. Nairobi: Swiss Tropical Institute, World Institute for Sustainable Pastoralism, Global Environment Facility, UNDP, International Union for Conservation of Nature.

Schelling, E., Wiebel, D., Taleb, M.O., Bonfoh, B., Bechir, M., Fokou, G., & Zinsstag, J. (2008b). Review of health service provision for mobile pastoralist families in daily life and situations of crisis. Basel: The Swiss Tropical Institute.

Scoones, I. & Wolmer, W. (2006). Livestock, Disease, Trade and Markets: Policy Choices for the Livestock Section in Africa, Working Paper 269. Brighton: Institute of Development Studies.

Shabazi, M. (2006). The Qashqa'i formal education and indigenous educators. In C. Dyer (Ed.), The Education of Nomadic Peoples: Current Issues, Future Prospects (pp. 175-192). New York, Oxford: Berghahn Books.

Simpkin, S.P. (2005). Livestock Study in the Greater Horn of Africa. Nairobi: International Committee of the Red Cross (ICRC) - Nairobi Delegation.

Smith, D.H., Timms, G.L., & Refai, M. (1979). Outbreak of botulism in Kenyan nomads. Annals of Tropical Medicine and Parasitology, 73, pp. 145-148.

USAID - Ethiopia. (2006). Pastoralist Llivelihood Initiative: Guidelines for Livelihoods-based Livestock Relief Interventions in Pastoralist Areas.

Weise, M. & Tanner, M. (2000). A preliminary study on the health poblem in nomadic communities: A case study from the prefecture of Chari-Baguirmi, Chad. Aktuelle Beitrage zure angewandten physischen Geographie der Tropen, Subtropen und Regio Trihena, 60, pp. 79-102.

WISP. (2007). Pastoral institutions for managing natural resources and landscapes. The World Initative for Sustainable Pastoralism.

Zinsstag, J., Schelling, E., Wyss, K., & Mahamat, M.B. (2005). Potential of cooperation between human and animal health to strengthen health systems. The Lancet, 366, pp. 2142-2145.