Earlier on this is worded as ‘Increasing accessibility of quality health services in pastoral areas’ (p.32).

This sectoral strategy is justified on the basis of the following premises:

1. ‘health services in pastoral areas have not been established in a manner that considers the livelihood and life style of pastoralists’ — this has resulted in inadequate access;
2. ‘the coverage and quality of health services in [pastoral] areas [are] found [to be] below the standard and the national average’;
3. health provision will be based on the mobile and sedentary lifestyle of pastoral people and be consistent with the policy pillars’;
4. ‘the major goal will be a form of prevention and control of diseases accessible to mobile pastoralists’ and ‘to all other communities’;
5. ‘it is important to make accessible mobile health services that could lay the ground work for future settled livelihood’ (p.52);
6. ‘it is important … to enable [pastoralists to] identify the differences in participation and benefits of settled and mobile life-styles … so that they would decide on their own to permanently settle’ (p.53);
7. ‘the main purpose of building health facilities and provision of health services is to enable the people to’: (i) ‘access basic services’; (ii) ‘grow in life and improve attitudes’; and (iii) ‘lead modern lives with the assistance of modern technology’.

The strategy is described as being aimed at acting on these premises with the following measures:

1. providing and developing ‘health services that are compatible with the national average and standard [and] based on the ecology of the area [and] taking the mobile pastoralists and [the] settled pastoralists into consideration’;
2. building health facilities and providing health services ‘around development centers where people have voluntarily settled; or are in the process of settling’;
3. establishing ‘health services that take people’s mobile condition, mobility season and ecology in to account’, ‘where the livelihood of the people depends on grazing and water and in moisture stressed areas where mobile pastoralists live’;
4. training and deploying young women as house-to-house health-extension agents with a focus on disease prevention.

COMMENTARY

1. Health services have been inaccessible to pastoralists. The description of this strategy acknowledges that people in pastoral systems have poor access to health services, and that this results from the fact that such services have been established without consideration for pastoralists’ livelihood and lifestyle. In other words, health services were not developed as now specified in policy objective (a), ‘by taking [pastoralists’] livelihood as the basis’ (p.26). The way forward thus would seem to be in finally reversing this legacy and establishing ‘health services that take people’s mobile condition, mobility season and ecology into account’.
2. Using health services as a tool for sedentarization? Despite acknowledging that lower-than-average access to health services in pastoral areas follows from a lack of consideration for the livelihood of people in pastoral systems, and especially mobility, the description of this strategy insists on using health services to persuade pastoralists to settle. Great emphasis is placed on recommending that mobile pastoralists experience better health services in development centers ‘so that they would decide on their own to permanently settle’ (p.53). Is this the way that the livelihood of people in pastoral systems is to be taken into account? By making sure they decide to abandon it? Fortunately, this emphasis on persisting with the approaches of the past is somehow lost in the description of the implementation activities under this strategy.

a. Strengthen health sector leadership (p.53) »