ICROSS Mother and Child health and infant care programmeas 2011

ICROSS and women’s health programmes , creating long term change 2011



2010 marks a significant milestone as we reach 30 years of public health programmes. When Dr Joe Barnes and I began our work, we never realised that it would become such a significant contribution in reducing poverty and disease. In this annual review, we will look back on some of the highlights over the last thirty years. Before looking at the new challenges, as we build the organization over the next decade. Together with our friends and partners, we have managed to extend our long term public health programmes despite extraordinary challenges and demand on our limited resources thanks to the dedication of hundreds of volunteers.

We have been able to achieve improved health services and significant reductions in water borne diseases. The great strength of ICROSS has always been a unique combination of long term commitment and evidence based research. Because we built all of our work through our local belief systems and traditions, this year has shown how effective the ICROSS model can be. This report marks a further milestone following the restructuring of the charity like all dynamic organizations we are constantly incorporating new ideas and improved practices. This report outlines a series of new steps we have taken to prepare ICROSS for the years ahead. On behalf of Dr Evan Sequiera and our board of directors, as well as our programmes and management teams, I thank you for sharing our work in this annual report.

Over 35% of children in ICROSS projects are underweight or stunted. Kenya has a population of 36.b million. Its life expectancy is 35 and falling. The average age of Kenyans is 17 years old and the chances of dying before the age of 30 are ten times higher than living in Europe. ICROSS remains committed from the last 30 years to the improvement of health in vulnerable communities and tribal groups. ICROSS has worked over the decades with many endangered tribes suffering from high infant mortality and maternal deaths. Infant mortality in Kenya in 2009 was 55 per 1000 compared with 4.6 per 1000 in the UK. With infant disease 200 times higher than in Western Europe, ICROSS is dedicated to reducing this suffering. In Finland, infant mortality rate is 3.47 per 1000, France, 3.3 per 1000. Kenya ranks 181st in the world with one of the highest death rates in East Africa.

Together with a strong policy of holistic obstetrics and gynaecology, ICROSS is building sustainable women’s health. For 15 years



Dr Michael Meegan, Founder





SAFE MOTHERHOOD

A critical part of improving health care is the priorities for safe motherhood. As part f ICROSS’ campaign for advocating for mothers rights, we focus on empowering mothers and involving them in decision making. As part of the millennium goals, we are committed to reducing maternal deaths. Together with our partners, we understand that basic health care alone is not sufficient to improve safe motherhood. Maasai mothers often have their first child at the age of 17yrs. ICROSS seeks to delay marriage and first birth. This campaign has been effective and has attributed to more girls staying in school. Through community based education in the local language, we are encouraging families to delay marriages and first birth until girls complete their education.

Risks in pregnancies: there are many life threatening complications and risks that occur in pregnancy. Sub-Saharan Africa has the highest death rate in the world. It is essential that all pregnant women have access to a qualified midwife. They require guidance and support during their pregnancy and after child birth.

Improved delivery: ICROSS is working to establish the most critical intervention of safe motherhood. This is to ensure skilled delivery at birth. ICROSS remains committed to building maternity units in all its clinics Reproductive health services: developed through local culture and language, we continue to provide high quality reproductive health services. These interventions are culturally sensitive and help individuals and communities be empowered by making their own choices. Since Sharon Wilkinson introduced reproductive health education into ICROSS health programmes in 1993, we have continued to provide education and information in homes, villages and clinics.

Prevention of unwanted pregnancy and unsafe abortion: over 75 million unwanted pregnancies occur every year; mostly in the poor world. Without effective family planning, unsafe abortions can kill and cause permanent harm. By ensuring effective family planning, contraceptive advice and trained counselling, we can greatly reduce risk.

Safe Motherhood Research: for 30 years, ICROSS has studied the impact of its safe motherhood programme. The longest and most significant of these studies took 20 years to complete. This study examined the reduction of no natal tetanus in new born children.

Partnerships in Safe Motherhood: in 2010, ICROSS extended its network of community based organisations, women’s groups and self help societies. Together with a growing number of partners including the ministry of health, we have continued to strengthen our capacity to provide safe motherhood.

CHILD SURVIVAL

Every day, over 30,000 children under 5years die from preventable causes. The vast majority of these deaths cost very little to prevent or treat. With over 30% of Maasai children endemically malnourished, it weakens their ability to fight illness. More than a third of all child deaths are related to malnutrition in the poor world.

The principle causes of infant deaths are neo0natel (37%), pneumonia (19%), diarrhoea (17%), and Malaria (8%). These four causes account for the great majority of preventable deaths. Our child survival programme is based upon effective immunisation, childhood nutrition and essential supplementation. The prevention diagnosis and treatment of respiratory diseases diarrhoea and malaria.



HYGIENE AND SANITATION

Over half of the poor world (OVER 2.5 BILLION PEOPLE) lack sanitation facilities. Over 1.6 billion do not have safe water to drink. This lack of hygiene and sanitation worsens poverty killing thousands of children every day. In rural schools, millions of girls are denied education because of the absence of private sanitation facilities. The burden of poverty is greatly increased by the lack of access to basic toilets and simple hygiene. ICROSS promotes and supports hand washing, personal cleanliness, health promotion and education.

Among these interventions is child to child, where elder children teach the younger children how to stay safe through washing. ICROSS continues to develop and build pit latrines which are ventilated and clean. It continues to provide sanitary towels to girls and improve access to water. In 2010, we extended our hygiene and sanitation education to more rural schools serving rural communities. With the help of friends and supporters, we have been able to make new commitments to build more latrines for primary schools in 2011

HIV/AIDS AND TUBERCULOSIS

Over 70% of the AIDS victims live in Africa. Africa has less than 6% of the worlds AIDS budget. The leading cause of death in adults in Africa is HIV related followed by Malaria. Both are preventable. In 2010, 2 million Africans became infected with HIV.

According to UNAIDS, 14.8 million children have lost one or both parents because of AIDS. Life expectancy had fallen by over 20 years across the continent. Kenya has one of the highest infection rates in the world; with over 1.5 million people infected (population 34.6 million).

1.2 million Children in Kenya, were orphaned by AIDS and in 2009, 80,000 people died in Kenya from AIDS related disease. HIV prevalence has reduces because of nationwide education and awareness campaigns. Only one in three patients is receiving effective treatment.

The national prevalence has fallen from 13.4 % in 2000 to 6.7% in 2008. ICROSS has been directly involved in a wide range of HIV programmes since 1992. Following the strategic plan 1995 to 2005, ICROSS implemented wide ranging prevention programmes. With AIDS education and family planning strategies, ICROSS extended its work into central and western Kenya. Following long term home care for terminal patients, ICROSS extended its support programmes tripling the number of patients reached between 1996 and 2002.



The comprehensive strategy included:

• increasing third level care facilities in three districts

• creation of comprehensive AIDS resource centres at district level

• Provision of support to over 400 community groups.

• Pioneering in Kenya, home based health care at grass roots level

• Community owned support programmes for AIDS orphans and vulnerable children

• Creation of networks to support carers • Locally developed ways of identifying

children most in need

• Emergency grant program for AIDS orphans

• Anti-retroviral drugs for AIDS orphans infected with HIV



Tuberculosis is a bacterial infection of the lung which is increasingly serious involving easily identifiable symptoms. Tuberculosis has risen sharply with 15 million sufferers at any one time in 2010. TB kills more than 1.6 million people a year (4,400 people every day, 1 person every 20 seconds). 98% of TB deaths occur in poor countries; the vast majority in Africa. Kenya has one of the highest numbers of TB victims in the world with over a third of a million. 28% of adult Tb patients also have HIV.

Since 2002, ICROSS has a specific TB support intervention programme. This programme is primarily focused in three districts; Bondo, Kisii and Nakuru and adopts the Directly Observed Therapy (D.O.T.) as part of the WHO strategy.



MALARIA

Over half of the world’s population is at risk because of Malaria. There are a million deaths caused by malaria every year but mostly in Africa. 20% of all childhood deaths in Africa are caused by Malaria. The average Kenyan child has four episodes of malaria a year. Every 30 seconds, a child dies from malaria. Africa accounts for 91% of deaths. 85% of deaths are in children under 5years old. Kenya is in the top five countries on the planet affected by Malaria; 11.34 million cases a year. Six of the millennium development goals depend on fighting malaria. Disease and death from malaria is preventable and curable.

The groups most vulnerable to malaria are young children, pregnant women, patients with HIV/AIDS. ICROSS maintains a long term strategy of research, public health, prevention, treatment and clinical referral in fighting malaria.

In 2011, we have extended our mosquito net programme over 3,500 nets. Our target in 2011 is to distribute a further 10,000 nets in our project areas. Mosquito eradication and breeding site control increased in 2010. Public health awareness programmes to reduce new cases of malaria increased in all programme areas in 2010.

With the partnership of the ministry of health, intervention programmes will increase throughout the 18 months.

PUBLIC HEALTH RESEARCH

Building on the effective research of solar disinfection, we have designed new and improved water projects in urban areas based upon the findings of our research team in Nakuru. Together with the Royal College of Surgeons and our network of collaborators, we have been sharing the results of the SODIS studies internationally. ICROSS Was directly involved in bringing SODIS to Cambodia through Care Cambodia.

An important part of our public health research is to share findings and results with other organisations around the world. The purpose of this research is for us to find out the best possible way of making an impact. As a dynamic learning organisation, we are constantly examining what we are doing and finding ways of doing it better.

The research team at ICROSS will be expanding in 2011 as we take on new challenges exploring new areas of public health and disease control. The research team is lead by Dr Michael Meegan with

Illustrative Research Articles and Publications



1. Elmore-Meegan M, Conroy RM, Agala CB. Sex workers in Kenya,

numbers of clients and associated risks: an exploratory survey.

Reprod Health Matters 2004;12(23):50-7.



2. Meegan ME, Conroy RM, Lengeny SO, Renhault K, Nyangole J. Effect

on neonatal tetanus mortality after a culturally-based health

promotion programme. Lancet 2001;358(9282):640-1.



3. Conroy RM, Meegan ME, Joyce T, McGuigan K, Barnes J. Solar

disinfection of drinking water protects against cholera in children

under 6 years of age. Arch Dis Child 2001;85(4):293-5.



4. Meegan M, Morley DC. Growth monitoring: family participation:

effective community development. Trop Doct 1999;29(1):23-7.



5. Conroy RM, Meegan ME, Joyce T, McGuigan K, Barnes J. Solar

disinfection of water reduces diarrhoeal disease: an update. Arch Dis

Child 1999;81(4):337-8.



6. Meegan M, Morley D, Chavasse D. Fly traps. Lancet 1997;349(9055):886.



7. Meegan M, Morley DC, Brown R. Child weighing by the unschooled: a

report of a controlled study of growth monitoring over 12 months of

Maasai children using direct recording scales. Trans R Soc Trop Med

Hyg 1994;88(6):635-7.



8. Conroy RM, Meegan ME. Dwindling donor aid for health programmes in

developing countries. Lancet 1994;343(8907):1228-9.



9. Meegan MK. Rethinking famine relief. Lancet 1992;340(8830):1293-4.



10. Konings E, Anderson RM, Morley D, O'Riordan T, Meegan M. Rates of

sexual partner change among two pastoralist southern Nilotic groups

in east Africa. Aids 1989;3(4):245-7.



11. Meegan M, McCormick J. Prevention of disease in the poor world.

Lancet 1988;2(8603):152-3.

12. Meegan M. Starvation and suffering. Lancet 1983;2(8365-66):1506.



13. Meegan M. The reality of starvation and disease. Lancet 1981;1

(8212):146.







ADMINISTRATION AND FINANCE DEVELOPING ICROSS

Over 30 years ICROSS has learned to be a dynamic listening and learning engine of change. The many publications, studies and works created from our programmes have taught us four things

1. Everythingisindynamicevolution

2. All that we do needs to be a wake to the past, receptive to the present and embracing of the future

3. Humans generally are poor at learning from their experiences in order to inform future choices based on knowledge.

4. The critical contribution of ICROSS lies in the focus and clarity of its public health research

We will continue to build ICROSS international within the context of evidence based planning, long term disease control and the prevention of infectious morbidity in Africa. In 2011, we are committed to the policy of inclusion, local ownership and cultural transparency.

We remain focused on basic primary health care, gradual reduction of poverty and 20 year programmes of community based health. No short term programme has ever demonstrated a long term effect; we continue to advocate for long term strategies in the reduction of starvation and suffering.

PARTNERSHIPS

2010 saw a series of new partnerships develop with ICROSS and another 35 community based organisations collaborated with our field programmes sharing common goals to reduce poverty and suffering. Building on a long history of community ownership and inclusive planning, ICROSS teams established new and exciting links, bringing in radically new perspectives to local development. All planning is done in the local language in keeping with the ICROSS principles.

b. GOVERNANCE AND RISK MANAGEMENT

ICROSS is committed to meeting the higher standards of best practice. As part of this commitment, our corporate governance policies have adapted and adopted the British Charity commission protocol requirements, stipulations, recommendations and guidelines regarding operational practice, codes of conduct and evaluation. As part of this international gold standard, ICROSS Kenya requires and demands of all of its partners a minimum of the adherence to the same international stipulations.

Available on our websites, we detail the corporate legislation and constitution that govern the transparency of ICROSS. Passed by Annual General meeting, are requirements that detail provisions and contingencies relating to the management of risk in all situations. T is the policy of ICROSS in Kenya to meet the highest standards of external scrutiny, probity and compliance. It is the policy of ICROSS to have a diligent, independent and external scrutiny of management operations and finance. As part of this commitment, in December 2010, the board of members voted two new Directors detailed at the end of the report. These are specialised in governance and law.



Learn more about ICROSS by visiting their web sites and blog

www.icrossinterational.org
www.icrosskenya.org

http://icrossprojects.blogspot.com/

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