This activity focuses on harnessing resources within pastoral communities in order to deliver on the provision of health services in pastoral areas.

It consists of:

• empowering pastoralists to participate in the planning, preparation, implementation, monitoring, and evaluation processes of health services;
• conducting activities that ‘strengthen pastoralists’ attitudes to be health conscious and to develop their sense of ownership’;
• creating and implementing health extension programs;
• ensuring community access to health services through the coordination of customary, religious, and clan organizations with the ‘women’s health army’.

COMMENTARY

1. Participation. The description of this activity opens by stating the intention to give pastoralists a voice in all processes of health services: ‘pastoralists shall be empowered to actively participate in health planning; preparation; and implementation; and monitoring and evaluation processes’. At least since the 1990s the use of the term ‘participation’ in development refers to a ‘people-centered approach’ as opposed to top-down and technocratic interventions. It is based on the principle that by listening to the people whose livelihoods are supposed to be affected by development, interventions can be more relevant and more effective. Participatory development is more community-driven and more process-oriented; development by and with people rather than for or to them. This meaning of participation is also used in the policy document, for example when it acknowledges that the ‘absence of development plans that were relevant and participatory’ has hindered pastoral development in the past (p.15). Thus, the opening statement in the description of this activity reads consistently with Specific Objective (a) which is about ‘responding to the demands of pastoralists … by taking their livelihood system as the basis’ (p.26).
2. Access. A second key statement in the description of this activity refers to ensuring pastoralists’ access to health services. Pastoralists’ currently have much less access to the service than the national average. This is largely due to the fact that provision of health services has been designed without taking pastoralists’ livelihoods into consideration. This makes the service largely irrelevant to pastoral areas and therefore poorly effective. That is why a more participatory approach is necessary. Ensuring access means redesigning the service so as to make it accessible to pastoralists — for example by creating mobile clinics.
3. A lingering top-down approach. The rest of the description of this activity appears to be unaffected by the emphasis on participation and access. Ensuring ‘communities’ have access to health services through the coordination of customary, religious, and clan organizations with the women’s health army’ puts the burden of securing access on pastoralists themselves. Even ‘participation’ in this light seems reduced to simply cooperating with the usual top-down, technocratic interventions. The problem with the fact that current health services have been designed without consideration for livelihood conditions in pastoral systems is thus turned on its head – as if poor access was a matter of pastoralists’ choice and the solution was to persuade them to use the service, rather than a matter of making the service in pastoral areas accessible to pastoralists. The intention to introduce participation and secure access is laudable, but clearly the traditional top-down approach lingers on here and gets in the way of innovation. This is an area where crucial work could be done at the level of regional states.

c. Improve human resource development and administration (p.54) »