Reproductive Health and Access to Water, Sanitation and Hygiene in Kajiado County, Kenya Kajiado County is a rural county in the south-east of Kenya, bordering Nairobi to the North, and Tanzania to the South. It is home to Maasai communities, including Nice Nailantei Leng’ete, Amref’s Global Ambassador to End Female Genital Mutilation or Cutting (FGM/C), who has been working for many years to reduce FGM/C across the region.
Amref has been working in Kajiado County for 11 years. Over the last three years Amref, with funding from Stitching Ondersteuningsfonds Zorg Welzijn en Sport (ZWS), has been delivering the ARPWASH Model project in Kajiado. Through integrated Alternative Rites of Passage and WASH interventions, this project aimed to improve Sexual Reproductive Health Services and Rights (SRHR) among adolescent girls and women of reproductive age. The project will end in June 2020, having reached 27,691 people. As a result of the project 23 villages have been declared Open Defecation Free (ODF) communities and 2,725 adolescent girls were trained on SRHR, life skills, and hygiene, and graduated through Community-Led Alternative Rites of Passage (C-ARP) instead of going through FGM/C.
A recent evaluation of Amref’s C-ARP programme in Kajiado County has shown that CL-ARP plays a decisive role in decreasing FGM/C, child, early and forced marriage. Since the programme started, FGM/C rates among girls in the region have declined by 24.2%, girls on average stayed in school for 2.5 years longer, and were more likely to delay marriage and childbirth, with teenage pregnancy declining by 6.3%.
Women in Kajiado County bear the greatest burden when it comes to access to healthcare and water, sanitation and hygiene (WASH). Women are at risk of complications from pregnancy and childbirth, early marriages, unwanted pregnancy, and FGM/C. 
There is also increasing evidence that the reproductive health of women and girls is disproportionately affected by lack of access to WASH services, due to biological and cultural factors. Integrating WASH practices into health service delivery in health facilities and improving access to WASH within communities has been shown to decrease both morbidity and mortality of women and girls. WASH interventions are cost effective and help to improve gender equality and human rights by giving women and girls more social freedom and safety and removing inequitable work burdens.
The COVID-19 pandemic, and resulting movement restrictions and school closures, has disrupted access to critical Sexual and Reproductive Health and Rights (SRHR) services and hampered authorities’ ability to respond to Gender Based Violence (GBV) and harmful practices like FGM/C, child, early and forced marriages and teenage pregnancies. Reports of these have risen over recent months and reduced physical interaction between health workers and community members has hampered the ability to track and monitor girls at risk of FGM/C enrolled on Amref’s C-ARP programme.

Amref's second phase of the ARPWASH model project to improve the health and well-being of women of reproductive age in Kajiado by integrating SRHR, C-ARP and WASH interventions. The second phase will address gaps that have been identified during Phase One, many of which have been exacerbated by Covid-19:
1.	Lack of online Tracking/Monitoring tool for 2,725 girls reached through the C-ARP
2.	At least 1,500 girls still at risk of FGMC, early marriage and unintended pregnancy
3.	At least 3,000 people still not reached with clean water sanitation and hygiene
4.	Seven villages (1,750 people) still practicing open defecation still practicing open defecation
5.	Limited public health infection, prevention and control measures
With funding from the Rabelais Trust, we propose to fill these gaps by:
1.	Training 90 Community Health Workers (CHWs) through our Leap digital platform on infection prevention at community and health facilities
2.	Supporting 1,500 girls at risk of FGM/C in the 7 villages
3.	Providing access to clean water for over 3,000 people in 7 villages.
4.	Supporting 7 villages (Shompole, Kilonito, Maparasha, Meto, Kiloh, Olenarau and Olgulului) to become ODF and FGM/C free communities.
5.	Attaching a trained CHW to each village to monitor and report all forms of violence against women and girls including FGM/C, domestic violence and Early Child and Forced Marriages (CEFM).
By the end of the project we aim to meet the following objectives:
1.	To improve infection prevention and control (IPC) among the target group(s).
2.	To reduce cases of FGM/C, early marriage and teenage pregnancy among targeted communities 
3.	To increase acceptance and support for the C-ARP model by cultural and political leaders.
4.	To generate evidence, share lessons learnt and best practices for ending FGM/C, early marriage and teenage pregnancy.