Because we want to make sure that our work in the HIV/AIDS and WASH (water, sanitation, and hygiene) spheres is making a true and lasting difference, we work with grassroots, locally-led organizations based in eastern and southern Africa who are already deeply entrenched in the community. We recently added a few new partners, and are absolutely thrilled to introduce one of them, Rafiki wa Maendeleo Trust (Rafiki)!
WHO THEY ARE
On the shores of Lake Victoria, three friends in the Rarieda sub-county of Kenya saw the trauma that the AIDS pandemic caused in villages throughout the region, and decided to get involved through health education and disease treatment. In 2001, they officially registered Rafiki wa Maendeleo Trust, expanding since then to include restoring dignity for orphaned children and young people who experience stigma, discrimination, and isolation due to HIV/AIDS. This work serves as an entry-point to community health. They believe in empowering people to believe in themselves, becoming agents of their own change, and influencing households to work together to build a vibrant, progressive community.
Among their main focuses are training community members on initiatives that provide income to support nutrition, scholastic materials, and psychosocial support and educating on skills for empowerment and vocation through the Rarieda Training Resource Center (RTRC). With community institutions like schools, government ministries, and households, they also provide things like HIV services, health initiatives, green energy, dignified livelihoods, decent shelters, business training, and microloans.
Their economic activities pursue strengthening caregivers and households’ capacities to provide services to those affected by HIV through enterprise development, skills training, apprenticeships, and positive messages through trained community health volunteers (CHVs), referrals for further care, and improved access to ART (antiretroviral therapy). They also manage an educational scholarship with secondary schools, colleges, and universities to help youths with school fees, scholastic materials, mentorships, and sanitary supplies.
They’ve already done a great amount of work in water and sanitation through water points and infrastructure that serves over 12,000 households, averting waterborne disease for every one of those people served.
2,108 CHILDREN EDUCATED
45,000 PEOPLE ACCESSING CLEAN WATER
15,000 ACCESSING HEALTH & SOCIAL SERVICES
2,038 FAMILIES WITH IMPROVED LIVELIHOODS
RAFIKI’S 3 PILLARS OF STRATEGY
This pillar is centered around the wellness of children and youth by bettering participatory, community-driven programs that reduce household vulnerability. A key challenge to addressing this is the prevalence of HIV locally, and the psychosocial needs associated with it. Children, chronically affected adults, and caregivers in rural areas may find opportunities scarce, so Rafiki helps them through skill building, education, nutrition, water, sanitation, housing, community safety, and social support to tackle issues such as depression, anxiety, low self-esteem, and anger. For example, when building new structures, Rafiki employs qualified constructors, consults families, sources local materials, and involves them in learning these skills for themselves.
Rafiki’s second pillar emphasizes their spotlight on communities acknowledging, appreciating, and utilizing education and skills-training for young people to find dignified ways of earning a living that they can take pride in. They provide opportunities for youth and families to learn skills that build their confidence and participate in progressive enterprises.
Rights & Civic Engagement
Lastly, Rafiki works with the community to advocate for their rights and strengthen service delivery for the health and well-being of willing children and youth. Especially for the rural areas they work in, understanding the role of local authorities, their rights, and the options available encourage individuals and households to feel and take ownership of their liberties.
All of Rafiki’s work is based on their goal to empower communities to create positive change, especially for children and youth, with strict adherence to their core values:
INNOVATION: nurturing talents for creativity and entrepreneurial spirit
COLLABORATION: commitment to teamwork and positive partnerships
EXCELLENCE: quality in service delivery and learning outcomes
RESPECT: recognition and advocacy for the uniqueness and dignity of every individual
INTEGRITY: high standards of ethical conduct including honesty, accountability, transparency, and trust
THE CHALLENGES THEY TACKLE
More than half of Rarieda’s population lives in poverty, and many people have trouble accessing quality water, sanitation, health services, education, energy, and housing. 64% of residents use water from informal sources like unprotected wells, springs, rivers or ponds, and have a primary level of education (only 16% have secondary education or above, and 20% have no formal education at all). About half of the population uses unimproved sanitation such as shared, open, or bucket pit latrines, and a quarter are living with HIV. The greater county, Siaya, has among the highest rates of HIV prevalence in Kenya. About 86% of people have homes with walls that are easily damaged by extreme weather, and Rarieda accesses electricity the least in Siaya, with most families using firewood to cook.
Kenya made significant progress in the fight against HIV/AIDS in the past decade, with adult HIV prevalence decreasing from 10.5% in 1996 to 4.9% in 2018. Overall, new infections and mortality among PLHIV was significantly reduced in Kenya from 2010-2019, while ART coverage has gone up. Kenya is, however, still deeply entrenched in the epidemic with marked disparities between counties and genders. HIV prevalence among women is almost twice that of men, and 26% of new HIV infections are among females between the ages of 15-24. There are also significant gaps in knowing who is HIV-positive, and linking them to and keeping them in treatment, particularly with children and adolescents.
Nyanza Province has about one out of three PLHIV in Kenya, and Siaya County has the second highest infection rate in the country, at 15.3%. Factors contributing to this include poor health seeking behavior, growing key and priority populations, and cultural practices. A study on risk factors among fishing communities of Lake Victoria shows they are about 31% of new HIV infections in Siaya County, and voluntary male circumcision is about 80.3% in 2019, significantly below the 90% target.
According to a 2017 World Vision report, PLHIV in Rarieda sub-county suffer disproportionately frequently and severely from the adverse effects of poor WASH practices because of their suppressed immune systems. Only about 15% of Rarieda has piped, treated water, and everyone else has to travel a long distance to get it, battling thick water hyacinth, heavy pollution by farm fertilizers, trash from markets, surface run-off, fecal matter from open defecation fields, and general destructive activities around the lake.
Because of a dearth of sanitation facilities, people openly defecate around market centers and social areas, and Aram market was the epicenter of a cholera outbreak that killed five and caused 100 serious cases in 2019. Loose soil makes many existing sanitation facilities insufficient, so cholera and other waterborne diseases continue to be a serious threat, particularly for PLHIV.
THEIR IMPACT AND COVID-19 RESPONSE
Rafiki was no stranger to the difficulties of COVID-19, and when it hit Kenya in March 2020, their teams moved swiftly to prevent viral spread in their community. They saw communities, partners, and funders come together to support their work and the people they help, and they continue to pivot when needed to reduce anyone slipping further into poverty.
Buckling down on business skills training encouraged out-of-the-box thinking and resilience at a time when unemployment across the country soared. Rafiki employed students in the production of student’s chairs, doors, gates, benches, shirts, mats, and face masks. Extending the evidence-based curriculum and practical, relevant training and coaching of street business schools to more women and youth built entrepreneurs’ essential skills to generate income, confidence, independence, passion, and resilience. These agents of their own change start sustainable businesses ventures rooted in the local economy with reliable income streams long into the future.
Many parents moved to the city to find work, but at the time, many had to send their children to grandparents and caregivers or move back to their rural homes. These families often had economic difficulties, so Rafiki supported the most vulnerable 60 families looking after 294 children with food and farming training through chiefs and village elders. To improve literacy, promote gender equality, and increase academic performance, they worked with caregivers in basic literacy and mathematics to improve household budgeting and farming.
When the Ministry of Education announced schools would reopen in September 2020, Rafiki prepared a budget and a COVID-19 committee to make posters for Rafiki grounds and classrooms on prevention and stigma. They installed nine handwashing points, supplied face masks made in the workshop, extended workshop space for social distancing, and acquired thermo-guns and sanitizers to check temperatures of everyone coming into the organization. Reopening the RTRC, they welcomed newly sponsored students and exam candidates preparing for government trade qualifications, and a fully equipped plumbing workshop with new tools and equipment. They also offered psychosocial support to students, and helped staff through on-line training and virtual meetings, working hard to quickly adapt facilities, training modules, and programs.
In September 2019, they started the Investing in Rural Education and Development (IREAD) Project to issue 275 e-readers and solar-powered chargers to six schools. Twelve teachers learned about e-reader usage and maintenance, and they overall found it easier to make references during class given the variety of exercises available to reinforce concepts. In 2020, these improved academic achievements and performance, and children could read independently and at night by clean, reliable, and affordable solar lighting, especially during COVID-19 when many couldn’t attend school. Caregivers save three to five dollars a month by not buying candles or paraffin, they generate income by charging phones for the community, and even have security lights outside at night!
Partnering with local organizations, Rafiki built 22 new houses big enough for whole families, benefitting a total of 111 children, and students from the training center worked with the community to install doors and windows they made. Psychosocial support activities typically aim to coach children in working together and respecting themselves, and at several centers, 1,149 children attended trainings and shared meals, and 346 girls received sanitary towels, especially important since many families consider these a luxury and couldn’t afford them due to lost income during the pandemic.
They installed solar infrastructure with pumps that treat water from Lake Victoria, reducing the time children and women spend walking to collect water, and upgraded existing projects for a more consistent supply for communities. Students and graduates worked with local institutions to install functioning toilets for 464 pupils, replace the roof of a maternity ward, and upgrade electricity and fencing for a health facility to deliver health services throughout the night.
One particular effort was an inclusive, community-led advocacy platform, the Rarieda Social Justice Center, as part of a country-wide network, since many are not aware of the correct process to follow to report cases. The Center is meant to act as a watchdog for the community, empowering people to participate in social justice with proper resources, and as a forum to share knowledge about actions that can be taken.
We started our partnership with Rafiki in April 2022, and our grant covering the next two years will focus on HIV prevention, treatment, care, and support for children and youth in vulnerable households in the Rarieda sub-county of Kenya. Scaling up services that improve their well-being and strengthen their households’ economic and social security will ultimately contribute to the 95-95-95 goals by accelerating HIV testing, treatment, and adherence to ART among people living with HIV (PLHIV). Long-term sub-county partners and the RTRC will play key roles delivering community WASH infrastructures, with masonry and plumbing students plugging sanitation facilities, water kiosks, and pipeline extensions into existing water supply schemes.
Rafiki will start off with Rarieda’s Health Management Team to work through health delivery structures already in place, strengthening sub-county planning and ensuring prominence of the HIV agenda. They’ll strengthen the facility referral system (particularly for vulnerable expectant mothers) with government program support, capacity support through on-the-job training, support supervision, and mentorships. Peer intervention will build community adoption of HIV prevention approaches and reinforce safe behaviors, and partnerships with government and international bodies, civil society organizations, and communities integrate resources.
“Imarisha” being the Kiswahili for “strengthen”, this project 1) aims to scale up HIV prevention services among high risk youth, 2) increase access to integrated HIV care and support among infected children and youth from highly vulnerable households, and 3) improve access to safe potable WASH for vulnerable households affected by HIV/AIDS.
The project is premised on Rafiki’s twenty years of experience in the West and South Uyoma Wards in Rarieda, which is also experiencing more droughts and floods, affecting food production, availability of safe water, soil structure for traditional latrines, ill health, vulnerability, and poverty. New households for service delivery will be identified through a vulnerability assessment and recruited with the Rarieda Health Records and Information Officer. Reviews at partner facilities and antenatal care clinics will help enroll HIV-positive cases into treatment and HIV support and partner groups.
One piece of this goal is to bridge HIV knowledge gaps equipping vulnerable youth to make healthy decisions, know their HIV status, reduce their risk for getting HIV, and stay in care if HIV-positive. There have been a number of innovative approaches to HIV testing in recent years, including targeted community-based HIV testing, school-and institution-based HIV testing, door-to-door testing, and self-testing kits, which help a lot for young people in particular.
Youth engagement will be based around the Youth Health Ambassadors (YHA) model, where ten YHAs will be trained to conduct peer education, work with boda youth transporters and young fisher folks, and provide comprehensive HIV prevention services including HIV and health education, risk-reduction counseling, and behavioral interventions. This will focus on priority populations at their places of work and households of contacts, and derive from hot spot mapping for high risk youth.
Working with stakeholders like beach management units (BMUs), HIV service providers, and Ministry of Health facilities will help implement best practices and immediately offer treatment to people diagnosed with HIV. CHVs and other HIV care providers will help ensure HIV-positive adolescents and young people stay enrolled in treatment.
The goal of this objective is to increase access to integrated HIV care and support among infected children and youth from highly vulnerable households in Objective 1. They will work with two health centers to provide a continuum of care to HIV-exposed young people through diagnosis, and linkage and adherence to treatment.
CHVs will facilitate HIV risk assessments for children with an unknown status, and referrals and follow ups for those testing positive, reporting monthly and meeting with social workers quarterly to discuss the outcomes of treatment, child protection, and social issues for households. Rafiki will also work to increase their capacity with things like technology, along with that of community social support systems.
Comprehensive patient-centered care addressing co-occurring health conditions, challenges meeting basic needs, and other social support can help keep people in care and treatment. Rafiki will register 20 vulnerable households in the National Health Insurance Fund for continued access to health services and with clinicians, social workers, caregivers, and CHVs initiate the disclosure process for children and adolescents living with HIV (CALHIV) at an appropriate age. Each will be linked to caregivers who will keep appointment diaries of their viral load, and be involved in a “treatment buddy” strategy and Operations Triple Zero (OTZ) clubs to support adherence to treatment. Alarm clocks and drug boxes will also help ensure timely and safe medication, as will toys for a quarterly children’s club to address social support and medicine issues.
Vulnerable CALHIV can get business grants and training on modern farming methods, the street business school approach, and financial management skills. Production groups will scale up Village Savings and Loan Associations, and youth from vulnerable households can join the RTRC and other vocational training institutions, apprenticeships, and entrepreneurship programs. CALHIV will be provided scholastic materials, school uniforms, school fees, school levies, and links to scholarships for secondary schools and adolescent girls will get sanitary products and hygiene kits. Vulnerable households with malnutrition will receive monthly food baskets.
The last objective in this grant cycle is to improve access to safe potable water, hygiene, and sanitation for vulnerable households affected by HIV/AIDS. Safe water helps PLHIV increase their viral load, which must stay low to prevent diseases they can’t fight off from taking over their bodies. Two high volume water kiosks will connect to existing water infrastructure projects to serve about a hundred households daily at subsidized rates, and two clusters of HIV support groups and OTZ clubs and other community members can get 100L for free.
Rafiki will give opportunities for young PLHIV and vulnerable households to increase their income through managing water supply. Rafiki will ensure resources are available to support operations and maintenance of all of these facilities, and the RTRC’s masonry and plumbing students will facilitate construction and plumbing of kiosks.
Support group members will be taken through business management, financial literacy, and street business school skills training. Members can access loans for personal investments, medication, nutrition, school fees, and scholastic requirements.
Members unable to access water due to distance and other logistical barriers will receive basic water filters, and training on basic household hygienic water treatments, purification, and handling. Schools with OTZ clubs will get modern sanitation facilities, and support group members will be trained on hygiene practices for community hygiene promotion. CALHIV will be trained on handwashing and hygiene practices to reduce diarrheal infections, plus handwashing equipment will be made and distributed at various meeting points for support groups, schools, and HIV comprehensive care centers.
WHY THEIR WORK MATTERS: ANNA’S STORY
When Anna joined street business school training, she was selling vegetables at a local market, where stiff competition meant she could only make about $1.50 per day. During coaching sessions, they reviewed her income vs. her spending, and she realized her business was not sustainable.
Her coach asked what her life goal was, and her answer was to get her children an education and to build a new house. Between her and her husband, a casual laborer who only made enough for food expenses, their calculations revealed there was no way their current income could make those dreams come true.
After learning about growing her customer base, she did market research and realized she could reach more people if she built a stall near the road, instead of in the market. Her customers and income quickly increased, and she also started selling more diversified goods, now making more than five dollars a day.
She put her savings in the village savings and loan association, and now believes she is on track to her goals. Since COVID-19 began, these coaching sessions have been even more helpful than expected given the economic volatility of the times for so many people, but she maintains, “I now believe in myself and I know I can achieve anything I desire in life.”
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Photo credit: Rafiki wa Maendeleo Trust Facebook