In Bungoma and Makueni counties, there have been significant changes made to respond to the needs of people living with disabilities following the UHC For Me project. The UHC for Me project was designed to simultaneously improve UHC principles of quality, equity and dignity at the point of service delivery and influence long-term, system-wide change for priority populations through national and county UHC planning, policy, budget and implementation processes. We worked with women and girls living with disabilities in the two counties to voice their demands for quality and accessible healthcare locally, while ensuring their perspectives inform county and national dialogues on UHC.
Listening to women and girls with disabilities
Since the onset of the UHC For Me project, women and girls with disabilities in Bungoma and Makueni Counties have shared their lived experiences and most pressing needs while accessing health care in their local health facilities: lack of ramps: disability friendly toilets; availability of family planning commodities; adjustable maternity beds; and disability competent health care workers emerged as top requests.
“For long, majority women living with disabilities of different types did not seek health care in health facilities because their previous experiences were shameful, I remember stories of women about how nurses were disrespectful to them during delivery. They assume women with disability should not get pregnant.” – Resident, Bungoma County
To make sure the ‘numbers’ work for people, especially for those who commonly experience inequality on the basis of sex, age and disability status, this dialogue must be broken wide open and owned by the grassroots. The joint partnership with the Youth for Sustainable Development (YSD) – Bungoma and Makueni Chapters – rallied the organizing power of young people to claim space in the ongoing health dialogues at the local level. Guided by a series of advocacy capacity strengthening activities led by WRA Kenya, the youth advocates have successfully mobilized women and girls with disabilities in their respective Counties to strongly articulate the ‘UHC they want’ through the implementation of the joint project dubbed UHC For Me.
“The village I come from, most people living with disabilities have no sources of income and majority are also abandoned by their families, many cannot afford transport to the health facilities leave alone the hospital fees. Women living with disabilities face stigma, and this has made most opt not to seek help in the past.” – Resident, Makueni County
While the general health needs of persons with disabilities are the same as everyone else and can often be met by primary health services, they may also have additional specific health needs related to specific impairments or comorbidity. These include access to rehabilitation and assistive devices (such as wheelchairs, prosthesis, visual supports). Studies have confirmed that women with disabilities further face a host of socio-cultural, financial and structural barriers which impact their access to healthcare. These range from being ignored and judged at the health facilities, to exclusive transportation options while seeking care, and even lack of insurance coverage that responds to their unique health needs. Through community validation meetings held in sub county villages and guided by the Power ON toolkit, the youth advocates worked closely with women and girl with disabilities to prioritize their health issues and design corresponding plans to demand action from their health decision makers.
“We now move around our health facilities with ease after the construction of ramps, the toilets are clean and disability friendly, we have adjustable delivery beds for mothers living with disabilities, health workers are more friendly and understand us better” – Elika Sanya, Resident, Milo, Bungoma County, Kenya
Working in partnership with Sustainable Development Goal Forum (SDG Forum Kenya), in Kajiado County, the What Women Want campaign exposed the gender imbalance at policy decision-making levels. Elected positions were entirely dominated by men; therefore, women’s voices were underrepresented. The Gender Mainstreaming Policy ensures that when senior officials are selected for appointment, their gender is a deliberate consideration. The policy endeavours to ensure that women’s perspectives inform priority services and interventions that expand access to employment opportunities and end harmful practices for women and girls. The policy also has key provisions on ensuring adequate WASH facilities in schools to support menstrual health and bolstered security measures at health facilities to prevent mistreatment.
Additionally, the What Women Want campaign inspired the development of a gender sector working group in Kajiado that has been consistent in working with other players and the county government to advance gender equality and help in the fight against gender-based violence.
The What Women Want campaign informed and inspired dialogue around gender-responsive budgeting, encouraging allocations to projects that support women and children. One powerful example is the Women’s Economic Empowerment (Ushanga Initiative) in Kajiado County, which aims to bring economic opportunities to women at the grassroots level.
“The campaign influenced how we interact as government, CSOs, and communities. It has inspired the development of a county gender sector working group. We all sit at one table, plan, and execute activities as a team. We are not in silos now.” –Eve Merin, Director, Gender & Social Welfare Department, Kajiado County, Kenya
Midwifery has long been underrecognized as a profession in Kenya, with investments focused on nursing alone. White Ribbon Alliance has made concerted efforts to elevate midwifery as a stand-alone profession, ensuring it is acknowledged in legal and policy documents and making it possible for midwives to chart their own career and practice pathway through the Midwives Voices Midwives Demands Campaign. Specifically, WRA organized a cohort of midwifery champions, as well as conducted a series of listening sessions and advocacy trainings with them, that helped to elevate the issue of midwifery in the media. As a result, and through close collaboration with the Ministry of Health, the Nursing Council of Kenya, and the Midwifery Association of Kenya, WRA prompted the development and launch of the National Nursing and Midwifery Policy and regulatory tools for nursing and midwifery education and practice in Kenya. This is the first such policy recognizing and incorporating midwifery in Kenya.
The next move is to advocate for midwifery autonomy and scope of practice as demanded by midwives in Kenya. Key to this is expanding the Nursing Council to a Nursing and Midwifery Council, giving equal voice and rights for midwives. Midwifery advocates drafted a bill that was tabled before parliament that proposed this amendment. Though the efforts are yet to be realized, WRA and the Midwifery Association of Kenya will not stop advocating to ensure that the demands by midwives are realized, and that midwifery attains status
“SMART advocacy training conducted by WRA Kenya, and the listening exercise gave me the confidence to speak up and demand that midwives be given their rights back. I was afraid in the past and did not know where to start or who to go to. I feel that now midwives have the power to own their problems and demand solutions from those who make decisions.” –Mark Katumila, midwife champion, Kilifi County
WRA Kenya is part of the consultative process that is supporting the Senate Reproductive Health bill, aligned around mental health, SRH, and women with disabilities. Currently in Parliament, the bill is contentious (dubbed the ‘abortion bill’ in Kenya) with many opposers. What Women Want responses were invoked for the consultative process, through which the bill’s final memo was co-developed. What Women Want demands were included in the 2nd reading of the bill. WRA has since brought in youth to speak to the importance of the bill. The East Africa Sexual Reproductive Health Bill mirrors the Kenya legislative piece.