This activity focuses on the task of funding the health sector in pastoral areas.

It consists of:

• ‘coordinating and leading all stakeholders involved in the health sector in pastoral areas under the framework of the Health Policy’;
• ‘improving the income source of health institutions with the participation of communities to ensure the sustainability of health services’;
• establishing ‘strong partnership with private … organisations’;
• conducting ‘capacity building and awareness raising activities at all levels’;
• ensuring ‘proper administration, use and control of the collected funds’;
• implementing ‘community-based health insurance, suitable to pastoral areas and drawing on the experience of other places’;
• establishing and strengthening ‘a disease prevention fund-generation system in health institutions’.

COMMENTARY

1. Leading stakeholders under the framework of the Health Policy. The first point in the description of this activity consists of ‘coordinating and leading all stakeholders involved in the health sector in pastoral areas under the framework of the Health Policy’. Do such stakeholders include pastoralists themselves? If not, this would seem contrary to this policy’s Specific Objective (a) and the intention to improve the health service in pastoral areas by taking pastoralists into consideration as emphasized in activities (b), (c), and (d) under this sectoral strategy. If pastoralists are included in the group of stakeholders, the intention to ‘coordinate’ and ‘lead’ them ‘under the framework of the Health Policy’ would seem contrary to Specific Objective (b). Specific Objective (b) is to ‘Guide sectoral policies and strategies … to be revised in light of the livelihood basis and ecology of pastoralists’ (p.26). If the Health Policy is included in the definition of ‘sectoral policies’, then following Specific Objective (b) it is the Health Policy that needs revising in light of the livelihood basis and ecology of pastoralists, not pastoralists that need ‘coordinating and leading under the Health Policy’.
2. ‘Participation’ in funding the health service. Point two of this implementation activity consists of funding health institutions ‘with the participation of communities’ to ensure their sustainability. In other words, establish a system through which communities in pastoral areas will contribute to funding the health service. The use of the term ‘participation’ here is clearly not with the meaning this word has in the description of activity (b) under this strategy: ‘pastoralists shall be empowered to participate in health planning; preparation; and implementation; and monitoring and evaluation processes’ (p.53).
3. Late service with a fee? Accessibility of health services in pastoral areas is below the national average as a consequence of the lack of adequate consideration in past policies for the living conditions of people in pastoral systems (p.51). This means that for decades pastoralists have done without services that were accessible to the rest of the country –decades during which those services were free. It is reasonable to expect that lack of access to health services had a negative impact on the pastoral economy while access to it had a positive impact elsewhere. Now this service is finally extended to pastoralist communities, but they are asked to fund it. How are they ever supposed to catch up following decades of neglect?

g. Improve the quality of the efficiency and accessibility of health services (p.55) »