Will Sagam Village attain the MDGs?

From Khama ROGO:

"The Millennium Development Goals (MDGs) signed by world leaders in 2001 are the new yardsticks for international development, to be attained by 2015. There are only ten more years to go, yet not many people in Africa have not even heard of the MDGs, leave alone know their significance. This is not acceptable, given that Africa face the most formidable of the challenges. This note assesses the probability of attainment of the MDGs by a modest village in the middle of Africa. We believe that we are the first African village to attempt this assessment.

At the 5th Asian-Pacific Population Conference in Bangkok(2002), Kofi Annan made a statement that is most relevant to Sagam village, Siaya District in western Kenya: " The Millennium Development Goals, particularly the eradication of poverty and hunger, cannot be achieved if questions of population and reproductive health are not addressed. And that means stronger efforts to promote women's rights, and greater investment in education and health, including reproductive health and family planning".

Today, Africa lies at the bottom of the league table of continents with reward to probability of reaching the MDGs; Kenya lies in the bottom half of the African league; and Siaya District has one of the worst socioeconomic and demographic indicators in the country. It is important to understand this as a prelude and to underline that Sagam is not a politically privileged village.

Here is how the village ranks its chances on meeting the MDGs:

Goal 1: Eradicate extreme poverty, eradicate hunger and malnutrition. One out of four people in the developing world lives in extreme poverty, earning less than US$1 a day. In Kenya, 56% of the population are below the poverty line. It is estimated to be around 70% in Siaya district. The district has no industry and no viable cash crops, most of it's income coming from expatriate labor. It imports most of the food and malnutrition is widespread. Sagam village has good soil but the population density is a setback. It could use the bountiful rivers to grow vegetables and fruits throughout the year. The district is a net importer of food to the tune of KSh. 100,000 per annum. RSA Development Trust is a local CBO working on income generation and the village has established a viable Micro finance bank that provides small loans 'Gramin' style. Women are utilizing these resources much better than men!Seasonal food shortages occur although there is no famine. The achievement of this goal is HIGHLY UNLIKELY in the current natinl economic environment. More investment is needed to accelerate agriculture and cottage industries and most important identify markets. Otherwise, poverty may actually increase.

Goal 2: Universal primary education. Globally, over 100m children are not in school for various reasons. Sagam contributes to this figure, despite having four primary schools, all of them overflowing; there are as many as 100 pupils per class in some schools. Previously school fees was the major obstacle to the attainment this goal but this has now been removed by the government. The present challenge is to build enough classrooms, ensure universal enrollment and completion, gender parity and raise the quality of teaching. The CBO is investing heavily in this area, within a progressive 'no child left behind policy, a bursary fund and care of orphans. A Village Polytechnic is also under costruction to cater for the many youth ful school leavers. Attainment of this goal is HIGHLY LIKELY, albeit with additional investment in facilities, books and teachers.

Goal 3: Promote gender equality and empowering of women. Two thirds of the world's 799m illiterates are women. Education is key to gender empowerment. Providing an extra year of education beyond the average boosts eventual wages by 10% to 20%. Women in leadership is not new to this area. Gem constituency, where Sagam lies, produced Kenya's first female mayor and parliamentarian (Mrs Grace Onyango). It has also been represented in Parliament twice by Mrs Grace Ogot, who rose to be Assistant Minister. Sagam has also elected a female Assistant Chief and a Councillor. Achievement of this goal is LIKELY, but will require targeted programs to counter culture-based biases and disempowering male attitudes. In this context, property rights and ownership and wife inheritance should be gieven special attention. The establishment of Gender Violence Center (GVC) at Sagam Community Hospital is a good beginning.

Goal 4: Reduce child mortality by 75%. Four million infants die annually in the first month of life, 99% in the developing world. Two thirds of these deaths are preventable using existing low cost interventions, costing less than US$3 per newborn. Neonatal mortality accounts for 40% of infant deaths in Africa. Infant mortality has risen in Kenya over the last decade and immunization rates have stagnated. Siaya district has one of the highest IMR in the country. Sagam village has the essential infrastructure to curb child mortality: excellent health facilities, staff, communication and all the services. Already Sagam's IMR is considerably lower that the rest of the district and has dropped significantly since Sagam Community Hospital in 1997. This goal is LIKELY to be achieved with full utilization of available facilities and application of child survival interventions at household level.

Goal 5: Improve maternal health and reduce maternal mortality by two thirds. 99% of the annual global maternal deaths of nearly 600,000 occur in the developing world, mostly South Asia and Africa. Another 20m women suffer non fatal complications of pregnancy and child birth while at least 70,000 women die from complications of unsafe abortion every year. Siaya district has one of the highest MMR in Kenya, estimated at 1,500/100,00 live births. Skilled attendance at delivery, availability of emergency obstetric care and post abortion care can prevent the majority of deaths. Sagam has good health facilities and is probably the only village in Africa running its own facility that offers comprehensive emergency obstetric care (CEmOC), including post abortion care (PAC). No wowan should die in Sagam and there has been none since the hospital became operational. (There were two deaths the week before the hospital opened!) This goal is LIKELY, but the with special attention to the demand side. Cost of services is a factor that makes TBAs a more accessible alternative. There are efforts to establish a community pre-payment scheme that should supplement the planned National Social Health Insurance to which the hospital is already affiliated.

Goal 6: Combat HIV/AIDS, malaria and other communicable diseases. In 2004, 40m people were HIV positive, 5m were newly infected and 3m died. Almost half of PLWA are women; half of the newly infected are adolescents. Africa has the highest number of PLWA and Kenya one of the highest infection rates in the region. Western Kenya and Siaya districts lead the national statistics of HIV infection (20+%). Condom use is still unpopular with strong resistance by men and the influential Catholic Church. Less than 1% of the infected are on ARVs. The village has not received any sizable support from the much advertised national HIV control programs supported by the World bank, Global Funds or PEPFAR. This is not for lack of trying. The bureaucracy is thick and not easy to penetrate. At current levels of interventions, it is UNLIKELY that the HIV/AIDS goal will be achieved although there is hope based on the existence of strong community organization and infrastructure that could be effectively mobilized. For example, Sagam Community Hospital is now a VCT center and is providing limited amounts of ARVs while running an extensive home based care program. There are innovative orphan care programs run by Yaw Pachi women's group and faith based organization but they receive no externel support. There are also several youth groups opening up discussion on sexual behavior. The hospital has established an excellent free TB diagnosis and treatment program which receives reagents and drugs from the government and provides monthly returns. The incidence of TB has gone up and is unlikely to be controlled for so long as the HIV/AIDS epidemic is ravaging the population and the stigmas are in place.
Malaria remains a major public health problem in the village and a major contributor to child mortality and anemia in pregnancy. It is the leading cause of hospitalization in Sagam. Treated bed nets are not readily accessible in the district except for a restricted research area under CDC/KEMRI. But it is LIKELY to meet the goal on Malaria if the Global funds and other support could focus on building the opportunities offered by the RSA Trust, its local network and the qualified staff at the hospital to improve accessibility of treated bed nets and newer antimalarials. Resistance to Chloroquine and Fansidar (SP) is high in Western Kenya.Typhoid and cholera are the other endemic communicable diseases. The incidence of typhoid has remarkably dropped following inauguration of the water project. Cholera is no longer a problem nor are other water related diseases such as trachoma. The achievement of this target is HIGHLY LIKELY.

Goal 7: Ensure environmental sustainability. Nearly 60% of 4.4b people in the developing world lack basic sanitation and access to clean water. The safe water goal has ALREADY BEEN ACHIEVED in Sagam and the sanitation aspect is on course. The Sagam water project is a shining example of how a village can attain self sufficiency in tis valuable commodity. Sagam is now also selling bottled water to the nearby city under the trade name of 'Western Springs'. Environmental conservation is a problem, due to the population pressure (Sagam is the most densely populated sublocation in the district), and wanton cutting of trees for construction and fuel. We have electricity but is rather expense for cooking. The CBO has intensified environmental work establishing tree nurseries in every primary school, introducing energy saving stoves, mandating a ' family tree corner' in every family plot to cover domestic needs and protecting water catchments/springs. With more effort and identification of alternative enegy saving sources, this goal is LIKELY to be achieved. The population growth factor would however have to be tackled and the CBD family planning program by the hospital is a good start.

Goal 8: Develop and strengthen partnerships. As seen from the above Sagam community is highly organised, with high levels of mobilization and community participation. The village has a healthy relationship with the government and has a clear road map to the MDGs. But, partnerships with major development partners and funding agencies remains surprisingly thin. Apart from the European Union which supported the water program and UNDP who gave seed support to the women's dairy project, the village relies on its own resources, especially the sons and daughters working outside and retirees at home. More could be done in this area to make this goal HIGHLY LIKELY. It will be interesting to see if donors can embrace the type of partnership that Sagam offers - not the hand down type. We strongly believe that herein lies the secrets to the attainment of the MDGs in rural Africa.

In summary, Sagam village scores rather well on its potential to achieve the MDG targets by 2015. This is due to the innovations, clear road map and investments that have been prudently managed over the last decade. Sagam is obviously has a head start over most African villages but is showing that IT CAN BE DONE....With proper leadership and sustained efforts.
Could the Sagam example be the beacon of hope for rural Africa?"