Africa Regional

Africa regional project on participation and advocacy

Health Poverty Action is working across its Kenya, Rwanda and Namibia programmes to strengthen the voices of the poorest and most marginalised in decision making about their health and wellbeing.

This includes pastoralist Somali groups in North East Kenya, remote rural communities in Rwanda, and the indigenous San people of Namibia.

The health outcomes of members of remote rural communities and cultural minorities are often much worse than national averages. These groups often face barriers to political participation, which means their need for culturally appropriate or tailored services and policies goes unmet.

Participatory GovernanceHealth Poverty Action has brought together civil society groups from three countries to learn from each other about how they can best engage these marginalised communities in decision making processes about their health. Country teams have then formed advocacy plans and are working alongside communities, local traditional leaders, and policy makers, to seek more and better involvement of excluded groups in health governance processes.

Our final report consolidates this learning, and examines three different participatory approaches we use alongside our partners in Namibia, Kenya, and Rwanda. We compare and share these methods, and draw out the best practices for the participation of marginalised groups in health sector governance. Read it here:

Participatory Governance: Sharing best practice for the participation of marginalised groups in health sector governance

Case-study: Tackling FGM in North Eastern Kenya

Health Poverty Action works to address female genital mutilation among the Somali community in Mandera County, northern Kenya. Mandera County has the highest maternal mortality rate in the country while FGM is practised as a rite of passage throughout this community.

We use the participatory method of Community Conversation (CC) to conduct dialogue on the issue of FGM. CC supports the community to discuss and explore shared values, question trends, build common understanding and consensus around the FGM practice from various angles and collectively apply the new understanding  to increase awareness and advocate against the harmful practice,  in order to bring about sustained change. The approach empowers community members including youth, men and women, opinion leaders such as the Sheikhs and Imams, elders and tribal leaders, circumcisers and traditional healers, to consider FGM as their own issue and come up with alternative perspectives to finally agree up on new norms and practices.

The CC groups in Mandera include religious leaders as a key stakeholder involved in FGM. Most community members think FGM is a religious issue, in a community that is predominantly Muslim.

The CC group of religious leaders discussed FGM with reference to the Holy Quran, raising awareness that there is no relation between FGM and the Muslim religion.

The group then agreed to produce bulletins on FGM which were distributed during Friday worship services and relayed to mosques across Mandera County. Community chiefs, women leaders and village elders were involved in producing and distributing these bulletins.

Sheikh Abdullahi, speaking on behalf of the association of sheikhs and imams, expressed delight at the unique approach. He cited an example of a prominent circumciser who abandoned her role as result of this initiative. Fardowsa (not her real name) has condemned the practice of FGM. She said ever since she was a young woman she had been practising FGM but this initiative has changed her way of looking at things, she now realises the consequences of this practice and has decided to abandon it.

Our work in Kenya, thanks to the support of the Commonwealth Foundation, is now being shared with groups in Rwanda and Namibia so they can use the same Community Conversations dialogue approach to raise health concerns of marginalised communities in their own contexts.
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