According to the 2019 census, 2.2% (0.9 million people) of Kenyans live with some form of disability. Article 54 of the Constitution of Kenya states that persons with disability are entitled to be treated with dignity; have access to educational institutions and all places, public transport, and information; use Sign Language, Braille, or other means of communication; and access materials and devices to overcome disability related constraints.
Between 2019 to 2021, Commonwealth Alumnus Hezron Ochieng was a Program Officer for the Voluntary Service Overseas (VSO) International in Kenya, working on the sexual and reproductive health program, Delivering Equitable and Sustainable Increases in Family Planning (DESIP), funded by UKAID. The programme was designed to promote and support access to sexual reproductive health (SRH) and family planning (FP) information and services amongst people with disabilities, rural poor women, adolescents and young people and other vulnerable, underserved, and marginalised communities.
The role of the VSO was to strengthen the knowledge and skills of healthcare service delivery officers and country health management teams to enable them to implement inclusive strategies designed to increase uptake, access, and utilisation of SRH and FP information and services amongst persons with disability, rural poor women, and adolescents and young people.
Understanding the barriers faced by people with disabilities
Prior to joining the program, Hezron did not have an in-depth understanding of how to utilise and develop such strategies. Under the supervision of VSO trainers, he soon became an expert in social and disability inclusive strategy development and was tasked with implementing a training for program partners and stakeholders.
Hezron liaised with healthcare workers to understand their engagement with people with disabilities and those in rural and remote communities on SRH and FP services. These initial discussions led to important findings.
“And to our surprise, most of them were telling us that, honestly, we have not been serving most of the people with disabilities simply because we do not know how to serve them. For instance, the deaf people. We don’t know how to communicate with them. Those who are using wheelchair, when they come to our facilities, we don’t have ramps for ease of access.”
It was consistently reported that healthcare facilities did not recognise the needs of people with disabilities in their service delivery. This ranged from a lack of infrastructure at healthcare facilities to support access, such as ramps and modified beds, to dissuading people with disability from attending healthcare outreach clinics as practitioners were not equipped to support their needs. In extreme cases, Hezron discovered that some people with disability had been denied FP services and were encouraged to seek sterilisation.
The information shared motivated Hezron to explore new ways he could train, educate, and support healthcare workers in developing inclusive practice through the program. Using his findings, he designed specialised training sessions, held open discussions to encourage questions and learning, provided mentoring on specific issues, and supervised the implementation of interventions at healthcare facilities.
Implementing inclusive changes to healthcare centres
Knowing how to support deaf patients was a concern shared by several healthcare workers during Hezron’s initial scoping. Whilst knowing standard greetings in sign language was identified as a way to create a welcoming environment at the same time healthcare workers need to communicate complicated medical information about SRH and FP services, such as how coils work, frequency of medication, and side effects, which requires a greater level of language fluency. Accurately and effectively signing this information to patients was something many did not feel confident in. With the cost of sign language interpreters prohibitive for most healthcare facilities, Hezron needed to find a cost-effective way to implement inclusive practice for deaf patients.
In response to this, he reached out to Kenya’s National Council for Persons with Disability (NCPWD). Together with the healthcare workers, the NCPWD provided technical support to VSO in designing a range of posters to communicate information about common terms used in medication and SRH and FP services. They also created posters with the Kenya sign language fingerspelling alphabet which has galvanised learning among some healthcare workers.
As a result of the program, Hezron and healthcare workers introduced several changes to support service delivery for people with disabilities. Alongside the support for deaf patients, 12 health facilities constructed ramps for wheelchair access and others mobilised their county governments to purchase adjustable examination couches and beds. Hezron also ensured facilities and centres were connected to local and national organisations representing people with disabilities, including the NCPWD. Subsequently, some healthcare facilities have collaborated with organisations to deliver clinical outreaches specifically for people with disability. Following the programme, these healthcare facilities have reported an increase in uptake of services from people with disabilities.
The training Hezron received and delivered during his time with VSO has made a significant impact on his personal and professional development and the skills and knowledge he gained have become critical in his subsequent roles.
“[I]t needs to really start from the leadership. So, as a leader, if I’m trained and sensitised on inclusive service delivery, then I will make deliberate efforts, make sure that as people get employed, I just tell them what they need to ensure that everybody is given the right to access services without any kind of physical, personal, or any other barrier.”
Challenging gender norms and delivering interventions for youth
With his passion for social and disability inclusive strategies in SRH and FP service delivery firmly cemented, Hezron took up the position of Program Advisor for adolescent SRH interventions with Save the Children International (SCI). The role was based in Turkana and Samburu counties where some communities practise strict and harmful cultural and gender norms that violate the rights of children. Hezron’s role was to coordinate the implementation of adolescent SRH interventions whilst addressing these practices.
The two counties have a high prevalence of teenage pregnancy, and early child and forced marriages amongst adolescent girls aged 10-12 are not uncommon. Young girls and boys may be denied the opportunity to access information on SRH, including issues related to puberty, the sexual reproductive system, and pregnancy, and once girls are married, they may also be denied access to education.
Designing a whole community approach to SRH rights
SC commissioned research into the local practices violating child rights to enable Hezron and his team to develop appropriate social and behavioural change interventions. As the violation of child rights occurred at the community level, Hezron felt it was important to introduce a participatory approach to tackle the damaging cultural and gender norms practised and identified the key groups he needed to work with. This included parents, healthcare workers, government officers, and children and adolescents.
Hezron invited representatives of these groups to analyse the SC research together to identify and acknowledge the challenges reported and develop interventions at the individual, community, and government/policy level.
Working collectively with government representatives was an important factor for Hezron. Bringing them on board from the outset of the programme meant they were active participants in identifying challenges and developing and approving interventions, making it easier for them to understand and engage with the programme. It also meant that following the end of the programme, the government would have clear accountability for continuing to uphold the rights of children in the counties.
“It’s very important to really bring the government authorities on board, because whatever we do as non-governmental organisations and other development agencies, our work is timed within a period… When the government is there, on a day-to-day basis with the people, it’s the responsibility of the government to be able to fulfil its obligations to protect the rights of people, irrespective of their age, status, race, and other spheres of life.”
Working with children and adolescents was a new approach for Hezron. To encourage participation, he contacted local youth groups to recruit youth ambassadors and created an Adolescent Advisory Committee. The ambassadors were tasked with representing and liaising with their peers to articulate the issues affecting them and contribute ideas to overcome challenges. Hezron created safe space meetings to encourage youth ambassadors to discuss SRH issues, learn about SRH rights and services, and report these back to peers.
Insights from the ambassadors enabled Hezron and his team to better understand the issues affecting young people and how to approach them. For example, they were advised to group and support young girls not just by their age but also by whether they were adolescent mothers or young wives. In some cases, those who were young wives or who had experienced adolescent motherhood had markedly different levels of education and expectations for life than their peers. By grouping them separately, it was easier for them to share the challenges they faced without embarrassment or shame, and for the team to develop appropriate and sensitive support.
In 2015, the Kenyan government published the National Adolescent Sexual and Reproductive Health Policy (ASRH Policy). The aim of the policy was to enhance SRH status of adolescents in Kenya and bring adolescent SRH rights into mainstream healthcare. Despite the publication of the policy, Hezron stresses that many healthcare workers, parents, and young people are unaware of the laws and policy provisions protecting their SRH rights due to a lack of policy implementation on the ground and insufficient education amongst these key groups.
“I’m happy that Kenya had the adolescence and youth sexual and reproductive health policy of 2015. But its implementation has been very weak … Even most healthcare workers and even adolescents and young people did not know much of its contents.”
Using the research gathered by SC and the Adolescent Advisory Committee, Hezron and his team delivered training to selected healthcare providers and managers and held workshops on pertinent issues, including SRH, puberty, child and adolescent nutrition, mental health, and hygiene. With adolescents able to access this information and parents and government also aware of the rights of children to access this information, Hezron hopes that in future harmful practices will no longer be common and children will be better supported by family, community, and government.
“… being able to understand that as a parent, you don’t have to really deny your daughter or your son the right to access information or even reproductive health services. Your work is to guide and provide age-appropriate guidance to your daughter and your sons and refer them to the health facilities for even further information, counselling and service delivery.”
Building on the foundations of the Commonwealth Scholarship
Hezron recently became the Country Coordinator for Kenya at Kindernothilfe. In this role, he provides technical assistance, capacity strengthening, and project monitoring to 13 implementing partners that deliver interventions on child protection, education, health, and livelihoods targeting vulnerable and underserved populations in Kenya.
Reflecting on the key takeaways from his MA in Education, Health Promotion and International Development at the UCL Institute of Education through a Commonwealth Distance Learning Scholarship, he shares that it provided him with good knowledge and competence as a facilitator and mentor for health and development interventions. These skills have enabled him to progress from officer roles to more senior coordinator positions at national and international development organisations.
“I’ve been able to take charge in various levels of responsibility in my work, in various parts of Kenya, with various organisations, which I believe has really also sharpened my mind so much and has given me higher platforms in terms of coordinating and managing projects, be it health, livelihood, education, or child protection issues, and so many other health-related advocacy issues, which I’ve come to like so much.”
Hezron Ochieng is a 2011 Commonwealth Distance Learning Scholar from Kenya. He completed an MA in Education, Health Promotion and International Development at the UCL Institute of Education.