The primary beneficiaries of RMF-supported Lwala Community Alliance are children, women, HIV-infected persons, and the elderly. Prior to the establishment of Lwala Community Hospital, there was no immediate access to primary health care or HIV/AIDS testing and care in the area. For this reason, Lwala’s health intervention has focused on primary care for children, access to medicines (particularly vaccines and anti-malarials), HIV testing and care, public health outreach, and safe maternity. The impact has been substantial since opening, though more work is to be done, and systems of measurement need to be strengthened.
Lwala saw increased patient numbers, possibly due to the free care newly offered for under-5 children and the likelihood of other family members simultaneously seeking care at the hospital. We are investigating the cause further. HIV testing and support was intensified during this reporting quarter; 2,854 individuals were tested and counseled, and 7 new support groups were created. The Lwala Community Hospital was registered with the Medical and Practitioners Board in Kenya; this is a major step in gaining accreditation for the Kenyan National Health Insurance Fund.
The service package that Community Health Workers (CHWs) are providing at the household level has been expanded to include home-based testing and treatment of malaria for children under 5. Through conducting thorough data checks and through CHW encouragement of child vaccination, 80% of Lwala children community-wide are now fully immunized. The involvement of men in women’s reproductive and general health issues has increased, in part due to a newly-formed committee that focuses on child protection and women’s rights.
In-school health clubs, in collaboration with RMF-supported Lwala Community Alliance, are constructing permanent handwashing stations that are fed by water tanks and supplied with soap. Two schools have completed construction and 11 are in the process. Structured observations of the eReader program were carried out by a Vanderbilt graduate student in May and June. The results of her observations are expected to feed into program improvements and an overall assessment of the impact of the eReader pilot project.
The economic team conducted a series of community consultation sessions to identify economic needs and areas of potential growth in the local economy, which will guide strategies of the economic development program. A partnership with Village Enterprise, a nonprofit dedicated to ending extreme poverty in rural Africa through entrepreneurship and innovation, has been formed, and a pilot project is planned to launch in the fourth quarter of 2016.
The Kenya EMR (Electronic Medical Records) system has fully moved to point-of-care usage at Lwala Community Hospital with all clinical staff working with HIV patients. Patient tracking is now taking place primarily through the online system. The Kenyan Ministry of Health and Planned Parenthood Global conducted data quality audits at Lwala Community Hospital, and the hospital received high marks from both organizations. Lwala Community Hospital gained recognition as the second best health facility in Migori County in terms of data quality in Kenya EMR.
A new centralized procurement process is now functioning within the Operations department; a stock room now stores frequently used items available for request from all departments. An M-Pesa account was created and is currently in use at Lwala Community Hospital, reducing the number of cash transactions. M-Pesa is a platform for mobile banking in Kenya. A performance management process has been rolled out in Kenya, starting with employee reviews at the management level. The process includes each staff member completing written performance reviews and having an in-person meeting with his or her supervisor to discuss goals and targets for the coming year.
Lwala is a village of approximately 1,500 people near Lake Victoria in western Kenya. Within an hour’s walk, approximately 3,000 additional people live in nearby villages accessible by dirt roads. Poor physical infrastructure, including impassable roads during the rainy season, lack of electricity and lack of reliable drinking water, have helped to create a critical healthcare challenge in Lwala. The mission of the Lwala Community Hospital is to meet the holistic health needs of all members of the Lwala community.
Approximately 30,000. The total population of North Kamagambo is about 16,500, and programs are a magnet to people beyond North Kamagambo.
Maurice Otieno Ochieng is a 3-year-old boy living in North Kamagambo. Orphaned after his father passed away and his mother left, Maurice’s grandmother, Persila Adhiambo Ogutu, became his primary caretaker. Unprepared to provide for Maurice and his two siblings, Persila struggled to maintain a healthy lifestyle for the children.
On a routine household visit, a Community Health Worker (CHW) discovered the three orphans in poor health. During her assessment, she found Maurice to be severely malnourished and anemic. After educating Persila on the importance of HIV testing, the Community Health Worker screened each child. To Persila’s surprise, Maurice tested HIV-positive. Given his status and declining health, the Community Health Worker referred him to Lwala Community Hospital. After an additional referral, Maurice began HIV and nutrition care.
Though Maurice was being treated, Persila still did not understand how he contracted HIV without engaging in sexual intercourse. Through several counseling sessions with the Community Health Worker, Persila came to understand and accept his status and agreed to provide full support in Maurice’s care. His health began improving as he attended regular appointments and took medications as prescribed.
In Persila’s words, “I am really happy that Maurice’s health has improved so rapidly. Even though he is taking ARVs, he is not different from other children. His progress has encouraged me to continue applying the information I was given by the Community Health Worker and the hospital.” Due to the commitment of the Community Health Workers and Clinical Officers, Maurice has maintained a suppressed viral load for several months. Persila vows to stay invested and is thankful for the support of the HIV team.