REEP experiences in Western Kenya

By Mary Corbett, based on an interview with Mary Makopkha, REEP

A communications graduate from Dayster University in Kenya, Mary Makopkha originally worked as a freelance journalist for several publications. She founded REEP (Rural Education and Economic Enhancement Programme) in 1997 to spearhead the fight against HIV/AIDS and other issues affecting her Butula-Busia community

The authors would like to acknowledge the contributions of REEP staff and donor agencies that have supported the project.

Busia district, in Western Kenya, borders Uganda and Lake Victoria and has an estimated population of 369,209 (August 1999 national census). The district is subdivided into six divisions, three bordering Uganda, and includes the town of Busia, situated on one of the main trading routes between Kenya and Uganda. The HIV prevalence rate in Busia is one of the highest countrywide, with estimates of 15.5% from antenatal clinics in 2002. This is substantially higher than the national average tested in antenatal clinics (8.7% for rural and 12.4% for urban populations). There are many factors contributing to this situation, the primary one being that Busia is the site of heavy border traffic and therefore hosts high concentrations of a mobile population, who tend to be linked to risky behaviour and increased sexually transmitted diseases such as HIV. There is a similarly mobile population around the Victoria lakeside.

Origins of REEP

Rural community where HBC is operating

REEP (Rural Education and Economic Enhancement Programme) is a local NGO operating from Butula town, also in Busia district. REEP's mission statement is "to improve the quality of life for marginalised groups in rural communities in Western Kenya". It was set up by a feisty, dynamic local lady called Mary Makopkha who originally came from Busia District but left for some years to further her education. With a degree in communications under her belt, she returned to her native area and decided to start up her own local NGO. She set this organisation up over seven years ago and, in her own words, reckons that "the first three years were very difficult and they achieved very little". However, to the outside observer, this seems a little overly critical - this period must have been an enormous struggle, laying the foundations of a now strong, grass roots level agency, focusing on community participation and working closely with local leaders. Presently, there are eighteen staff working for REEP, and 40 community health workers (CHW) receiving some financial support.

Community support

REEP is a grass roots organisation, working with community management committees (CMC), which have been set up with total transparency, elected by the community. Many of the people within these committees are living with HIV/AIDS. The CHWs are the corner stone of the activities, and work under the supervision of the REEP Home Based Care (HBC) department. Training of the CHWs is arranged by the REEP office, in collaboration with Pathfinder International. A total of 40 CHWs are working in this programme, initially trained by the Ministry of Health (MOH) and Pathfinder International, with further ongoing training provided through the MOH. Income generating activities are initiated at two levels, firstly at REEP office level and secondly, at the support group level, with the assistance of the CHWs.

The CHWs are instrumental in supporting the carers. As patients are often very sick, depressed and angry, it can be difficult to look after them, "occasionally carers will run away". Therefore it is important to have a support mechanism for the carer. At present, the CHWs look after around 3,000 persons living with HIV/AIDS (PLWHA). Many of these clients are well, but as they become very ill and possibly bedridden, the CHW will step in to help the carer with the nursing care.

In addition, 18 support groups have been set up for PLWHA. These groups support one another, organise meetings and plan activities. As they have openly acknowledged their HIV status, they are frequently an important resource in trying to reduce stigma within the community.

There are many other 'off shoot' activities of this community based organisation, e.g. supporting orphan children with school fees, advocating for change in the widow inheritance custom, supporting families of people dying with HIV/AIDs, in particular protecting their assets (often family members of the deceased come to claim all the property).

Food aid programme

A baseline study was conducted prior to the food aid component of the REEP intervention, which started in 2003. The project goal was to 'improve food security among vulnerable households, especially those headed by children and old grandparents'. The food aid component aimed to support PLWHA and their families during crisis periods. A family ration was given, with an extra individual ration of corn soya blend (CSB) and oil to the person infected with HIV/AIDS. The initial food was targeted at families identified by the CHW and the CMC, but due to resource constraints this has proved unsustainable. Plans are now in place to look at food being given for 4-6 months only, focusing on the hunger gap period. Although there is not a major focus on antiretroviral therapy within this programme, MSF is also working in the area and medicines are available free of charge for those identified as requiring them.

Income generation

Small scale income generating activities have been initiated, including community gardens and small livestock distributions. It is planned that the community gardens will be at village level. In the past, maize has been the main staple grown in the Busia area, however this does not grow well. Instead, initiatives are in place to plant more cassava, sweet potato and traditional vegetables, as well as more sorghum and millet. Some women were given a small sum of money to set up their own businesses, or to support already established business.

Impact

Although it is difficult to measure impact, the REEP team feel that there are far fewer deaths from HIV/AIDS since the food aid programme has been introduced. "As many as 15 people were dying a month, now some months go by without any deaths". Mary Makopkha feels that many people died from starvation rather than opportunistic infections. At an ENN interview with a support group of PLWHA (approx 20 people), there was very vocal support for the food aid. They all claimed their health had improved substantially, they had physically gained quite a lot of weight, and that they "felt much better." Many had gone back to work and all were mobile and looked healthy. Respondents also claimed that they were able to tolerate drugs better. As some drugs need to be taken on a full stomach, compliance is compromised where households are food insecure. Many in the group said that the combination of the co-trimoxozole (Septrin) and food assistance had made a major difference in their well-being.

An impact study (still in draft form) suggests that the very poor households that receive the food assistance derive a large proportion of their diet from this food aid. In a community where 54% of the population are in the absolutely poor category (WFP baseline study), it is difficult to target the most needy. However, it appears that by targeting through the CMC, the most needy were better targeted.

There is close monitoring of the programme - one CMC was disbanded for abuse of food aid - but despite strict targeting criteria, there is some redistribution of food due to the high levels of poverty. Awareness of the lack of sustainability of long term food aid assistance has given rise to income generating activities to address chronic food insecurity.

The WFP programme evaluation (draft) of all implementing partners suggests that, in general, the programme is very beneficial. Wasting in children aged less than 5 years amongst participant households has been reduced, compared to non-participants. Meetings with the REEP staff and support groups indicate that a strong grass roots NGO with a home based care component has contributed to the success of the programme. In particular, stigma and behavioural changes may have been more effectively addressed, as all the staff are local and well aware of the context of HIV/AIDS within their community. Further- more, strong community participation at all levels, with substantial female participation, has led to empowerment of women in the community, and better targeting of food support.

For further information, contact Mary Makopkha, REEP Programme Director, P.O. box 47-50405, Butula, Kenya. Tel: Kenya 0734-643846.