Whenever traders troop to Ngiya town in Alego Usonga sub-county every Tuesday, a peculiar group of men with an insidious motive strategically parade themselves at one corner of the busy market ogling passing groups of female clients seeking to engage in tero.
To an ordinary market-goer who does not appreciate the culture of the local people, a group of men sitting at one corner of the market with empty tins at their feet does not realise that these tins provide a cultural mechanism of communication for widows desperately seeking to be inherited through a process popularly referred to as tero.
A widow seeking to be inherited , locally referred as Chi-liel will pass near the men and pick her possible suitor by deliberately knocking down her choice’s (man) empty tin.
Once this happens, without any verbal communication, the potential suitor automatically knows he has been picked to inherit the woman and follow her home.
Some of the men at Ngiya market are professional inheritors who are paid by either relatives or the widow herself to save her from “shameful” social isolation in some functions. Some of these professional inheritors are known for engaging in multiple relationships in Siaya.
But long before tero happens, the widow would have undergone through another practice known as Okola, a ceremony that involves sexual liaisons for cleansing purposes after her husband’s death.
The man responsible for this cultural practice referred to as “kukata okola”, is not supposed to marry the widow. Such man’s role is simply for cleansing purposes and there has now mushroomed a group of professional Okolas out for easy time but risky lifestyle
But the greatest health challenge that stands on the way to fight HIV/Aids and other sexually transmitted infections is the belief in unprotected sexual affairs during the two cultural ceremonies.
Both partners deliberately refuse to use protection. In this culture, wife inheritance and ‘cutting Okola” are not complete if protection is used.
“Wife inheritance has just to happen in this society. If you use protection, you are said not to have been inherited,” says Siaya County HIV/Aids coordinator Odera Wayayi who has a vast knowledge in this culture.
The other major concern in Siaya and which partners have also teamed up is the issue of a high number of teenage pregnancies representing 37 per cent of all pregnancies in Siaya County and forcing hundreds of girls to drop from school prematurely.
Since the launch of the Beyond Zero initiative in November 2014, the campaign has attracted collaboration with about 40 other partners working in Siaya under various programmes, all aimed at improving health indicators in the county, especially cutting the numbers of new HIV infections, improved maternal and child health, nutrition, retention of the girl child in school, family planning, skilled deliveries and curative services for various infections.
Chief among these partners include the county government, Amref, Unicef, Enabling Sustainable Health Equity (ESHE), Plan International, Kenya Education Trust (Kemet), Impact Research, Afya Plus Kamili, Care Kenya, Orphan care and Essential Health Services who are the key partner on Aids.
Although the Beyond Zero initiative was initially targeted at maternal, child health and HIV/ Aids interventions, it now provides health services across the board, both diagnostic, curative and preventative.
Some of the most prevalent health challenges in Siaya include malaria, malnutrition, upper respiratory tract infections, pneumonia, cervical and breast cancer screening, and hypertension.
However, the other partners that have been spurred to action by the Beyond Zero spirit have also come up with innovative initiatives that are all aimed at improving the health indicators in Siaya.
Siaya County’s First Lady Mrs Rosella Rasanga has come up with her own initiative, Rossella Vow (Voice of Women, Voice of Progress) through which all mothers seeking skilled deliveries in health centers get incentives aimed at attracting more expectant mothers to seek professional care in health facilities.
The “Mother Baby Pack” (Wadage- which means we have refused more mothers and babies deaths) gifts women who deliver in health centres with warm clothing for their babies and a leso for the mother.
“Through this incentive, mothers and children dying at birth has reduced significantly”, says Mrs Rasanga.
Her initiative also seeks to retain more teenage girls in school by extending mentorship programmes in schools and issuing them with sanitary pads and motivational materials to ensure they are not cheated through cheap gifts by men.
The programme also empowers female small traders and entrepreneurs through training, cash transfers and table-banking services.
Amref, another key partner has launched a Sh400 million programme on Reproductive, Maternal and Newborn Child Health whose main focus includes nutrition, capacity building and facilitation of Health Care workers.
Another key component of the Amref programme is the establishment of comprehensive youth-friendly facilities within the health centres that will incorporate units for contraceptives, private counselling and testing for HIV/Aids and games.
This programme is aimed at attracting the youth to the health centres for various interventions on health matters.
ESHE, the greatest partner on Family Planning and Nutrition provides all modern FP methods, both short and long term, across the County.
“Using the Beyond Zero mobile clinic is more convenient to us because of the numbers we can reach through the initiative. We do 2-3 outreaches in the county monthly”, said Michael Awallah , ESHE’s Siaya County coordinator.
Unicef has started a new programme in Siaya aimed at ensuring all villages are defecation free.
Through a special water and sanitation programme, Unicef wants all Siaya residents to construct and use latrines in every household in a programme dubbed Open Defecation Free (ODF) Districts. This is aimed at improving hygiene of the people and create a safe environment.
The County Government, besides supporting the Beyond Zero Mobile clinic in terms of fuel, payment of allowances for health care givers, also pays a monthly stipend of Sh3,000 each to over 2,148 community health volunteers whose work include door-to-door and community health talks on nutrition, mobilising pregnant women to attend both post and antenatal clinics and the immunization of defaulters.
Other roles of the CHV include HIV and malaria testing, provision of baseline Malaria drugs, providing oral rehydration salts to sick children, providing water treatment compounds, mobilizing people to attend BZ clinics outreaches and reaching out to youth with condoms.
According to the Siaya County Executive Committee member for Health Dr Olang’o Onudi, the county has witnessed a lot of improvement in health indicators since the launch of the BZ initiative.
“Maternal and Child mortality rates have dropped significantly”, said Dr Onudi.
“Skilled deliveries are currently at 62 per cent up from 45 per cent in 2011”, adds the CEC attributing the improvement to around the clock service delivery by the health staff housed within the hospitals.
The county has a total of 180 health facilities that include 10 public and 19 private hospitals.
Another key project that has made an impact in the health sector, especially in the lives of prematurely born babies is the Hewa Tele Oxygen Plant commissioned at the Siaya referral Hospital in November 2014 by the First Lady Margaret Kenyatta.
The inaugural Oxygen plant supported by the General Electric under through the Centre for Public Health and Development now supplies the vital oxygen in varoius regions including Kisumu, Nakuru, Migori, Busia, Vihiga and Homabay counties at a subsidised rate.
Siaya has an estimated population of 935, 000 people and is administratively divided into the six sub-counties of Alengo Usonga, Unguja, Ugenya, Bondo, Rarieda and Gem.
--PSCU