Irakoze Chanceline, a 22-year-old mother of four, arrived at the makeshift camp in Gatumba in March this year after floods destroyed her house and property. "I want my children to stay healthy," she said. "That's why I make sure they get all the necessary vaccines."

A small town bordering the Democratic Republic of the Congo, Gatumba has been battered by the torrential rains that have deluged Burundi repeatedly during the past three years. An estimated 10,000 have been left homeless. About 7,000 of them are sheltering in the internally displaced persons (IDP) camp where Irakoze and her children are staying.

There is a small health centre in the camp, Irakoze said, from which vaccination drives are coordinated. "The recent polio vaccination and other campaigns they find us at our tents, but also sometimes we are given dates to come and vaccinate our children at this health centre."

She has been advised, for instance, to return with her nine-month old youngest child when she is 18 months old. But she worries about further disruption: "The rainy season has started. Now we are worried about the floods again, and the hygiene of the places," she said.

Health worker Mushimiyimana Willermine, who works at the camp clinic, adds that sometimes the facility runs out of medicines and support.

 "We have doctors coming from health centres in Bujumbura, and the health workers have helped greatly here especially to maintain good hygiene. But we need more support from the government and other partners for this health centre to be able to accommodate all the people here," she said.

Cholera looms

Cholera is an increasing worry as the weather changes. Cases of the waterborne infection were recorded in Burundi even in the dry season, with the Ministry of Health declaring an outbreak in Bujumbura in early September. Now "we are into rainy season so there is a very high risk that the cases of cholera will increase, and what we can only do is to transfer them if nothing changes," says Mushimiyimana.

"We need more sensitisation on cholera, because the IDPs need to be sensitised about the measures to prevent the spread of cholera. Sensitisations were conducted, but are not enough, on how you can get infected, how to prevent and the cause [of cholera]," she added.

Mapping a path to safety

Burundi's government says it is working to make sure that the displaced people get access to health care, and to increase the human resources dedicated to preventing more property and life losses.

"We have now developed a multi-risk map. This helps us in planning and decision-making that makes it possible to understand the risks and better manage their effects, hence reduction in catastrophes," said Anicet Nibaruta, the Director General of the National Platform for the Prevention and Management of Natural Disasters. The platform is under the Ministry of Internal Affairs and is in charge of providing both early warning information and disaster management to the country.

According to Anicet, Burundi has lost some $98 million due to climate change related challenges. "We have studied risk areas including Gatumba, where a 2km dyke is being constructed to prevent the floods from river Rusizi," he said.

Despite the government stepping up their early warning mechanisms, health workers in Gatumba are calling for more support for their efforts to keep the IDPs in the makeshift camp healthy today. - Gavi the Vaccine Alliance

NAIROBI, Oct. 12 (Xinhua) -- Some 2.8 million Kenyans in arid and semi-arid areas are still in need of food aid due to persistent dry conditions in the regions, the drought management agency of Kenya said in a report released Thursday.

The National Drought Management Authority (NDMA) noted that those affected are in 23 counties, 18 of which are in the normal drought phase, while five are in the alert phase and require close monitoring.

It said the nutrition situation was above the long-term average in 52 percent of the counties, with 11 on a worsening trend. "The poor nutrition status is a result of previous failed seasons, thus livelihoods are still in recovery mode," the NDMA said.

The agency also observed that most of the arid regions had experienced a decline in vegetation conditions, with the situation attributed to rising temperatures.

The NDMA expects the tough conditions in the arid areas to improve with the onset of the October-December rainy season, where the East African nation is projected to receive heavier than normal El Nino rainfall.

The Intergovernmental Authority on Development (IGAD) Climate Prediction and Applications Center expects the rains to start in Kenya and the rest of the Horn of Africa from mid-October, positively impacting agriculture in areas that won't experience flooding. - Xinhua

All Ugandans irrespective of age or employment status will have to fork out Shs 15,000 per year should the cabinet approve the proposed National Health Insurance Scheme bill, Health minister, Dr Ruth Aceng has revealed.

There have been various failed attempts by the Health ministry to establish the National Health Insurance Scheme since 2004. The latest attempt was last year when parliament passed the bill only to be withdrawn shortly after. Now, Aceng says in the new proposals, they are making it mandatory for everyone to join the scheme after establishing that Ugandans don’t appreciate what they don’t pay for.

"We have done a good job consulting many people and drafting this bill. In this bill, the National Health Insurance Scheme it is mandatory for all of us to join. Mandatory! When I say it is mandatory it means you don't have a choice whether you're working or not working. Whether you're in the village or whether you're a boda boda [rider], it is mandatory! Because people don't appreciate services that they don't pay for and I can give you very good examples. When you go and find patients in Nakasero hospital, they behave, they don't break the toilet door or pull off the doors. They use the toilets very well and they pay for their services. But go to Mulago, they want to pull off the door, they want to break the windows, the beds are mishandled. People don't appreciate what they don't pay for," said Aceng.

She adds that the more dependants one has, the more money they will be required to contribute to the pool.

"I'm going now to tell you the sad news. The sad news is that the more the dependants and the more the children, the more you pay because you have to pay for your dependants, nobody is going to pay for your dependants. So if you're a hajji here and you have 3 wives with 25 children you pay your Sis 15,000 per child - all of them. And me who has 4 children, I will pay for the four. But if your child is 18 and above let them pay. Those are adults, we must instill in our children a spirit of hard work. You can give them some work to do and they pay for themselves and that way we shall be able to mobilise resources. We need money and when you have money you can get better services," added Aceng. 

However, experts differ on the idea of having everyone contribute to the scheme. In an earlier interview, for instance, Dr Githinji Gitahi, the AMREF Health Africa chief executive officer suggested that the government does mapping to determine, which people can afford to contribute irrespective of whether they work in the informal or formal sector.  

He suggests the use of village health teams (VHTs) to determine those who can afford the annual contribution and this he says has to be a continuous process because poverty levels keep changing. On her part, Grace Kiwanuka the executive director of the Uganda Healthcare Federation (UHF), says that the government’s proposal to have everyone pay irrespective of their financial capacity is a welcome move as it will protect the integrity of the fund.

“Where people don’t contribute experience globally is all beneficiaries need to contribute to appreciate the scheme and not to abuse it. To ensure the risk pool is managed, they consume responsibly because their money is in there as well," she said.

According to her, people are already paying for their healthcare anyway, and that health cannot be free or funded fully by the government as there is no big enough tax base. However, in the new proposals, the formally employed who are already covered by private health insurance will continue with their insurance plans already subscribed to, though they will still be mandatorily required to contribute to the NHIS. - URN/The Observer