Kenya: Lwala Healthcare Project

Program Updates

Hospital Program

• 15,439 total patient visits were provided at RMF-supported Lwala Community Hospital thus far in 2019.
• In 2018, we maintained a 98% elimination rate for HIV-exposed children. In November, we graduated our cohort of 63 HIV-exposed infants from the elimination of mother-to-child transmission (eMTCT) program. Of the 64 children that were enrolled into this cohort in May 2017, only one child has tested positive. A cohort of 83 HIV-exposed infants are currently enrolled in this program and will graduate in November.
• Through our community-led reproductive health model, we have drastically increased contraceptive uptake. In fact, we provided 4,210 couples years of protection, which measures the number of years a couple is protected from pregnancy, in quarter one of 2019.
• 14 Lwala villages have been internally verified as Open Defecation Free and are awaiting Ministry of Health certification. Because of our success providing sanitation coverage in our innovation hub, Lwala has been tasked to lead all villages in North Kamagambo to become Open Defecation Free.
• This year we will scale-up the non-pneumatic anti-shock garment (NASG) intervention to treat obstetric hemorrhage, a leading cause of maternal death. To date, we have trained 17 facilities, including three tertiary facilities and 178 clinical officers, on the NASG, and distributed 40 garments. We plan to train approximately 30 more clinics.

Public Health Program

• 10,963 children under-five regularly received care from our cadre of 204 Community Health Workers across our innovation hub (North Kamagambo) and expansion site (East Kamagambo)—a 68.8% increase from our quarter one 2018 enrollment rates.
• We continue to provide education to community members on the consequences of poor sanitation and the benefits of latrine construction through an intensive community-led total sanitation (CLTS) initiative. This year, 14 villages in our catchment area were certified Open Defecation Free by a third-party verification firm contracted by the Ministry of Health. After villages are certified, we begin working with them on water infrastructure projects. So far, two villages have completed water access projects to rehabilitate broken handpumps.
• Lwala has continued to exceed its target of fully immunizing 90% of children under 5. We achieved an immunization rate of 97% for quarter one 2019, which is significantly higher than the county rate of 57% (DHIS 2014).

Education Program

• In January 2019, we had 120 girls re-enroll in school as part of our Broaden Horizons mentorship program. This program targets young mothers who have not completed their secondary education and provides them with a starter package of notebooks, uniforms, and a micro-grant to incentivize them to re-enroll. This is our highest number of students to re-enter to date.
• For the 2019 school year, we provided 780 girls with school uniforms and 1,012 girls with sanitary pad kits. We also provided mentorship to 394 girls in school who have been identified as high-risk students by their teachers to ensure that they remain enrolled in school.

Monitoring and Evaluation

• In September, Lwala published a peer-reviewed article with Vanderbilt University in PLOS ONE (the Public Library of Science journal) on our achievements in under-5 mortality in Rongo-Sub County.1 This cross-sectional survey found a significant decrease in under-five mortality following the establishment of Lwala Community Alliance. Between 1999–2006, before Lwala’s intervention, the under-five mortality rate was 104.8 deaths per 1,000 live births. After Lwala’s intervention, this rate was 53 deaths per 1,000 live births, and in the last five years this number has decreased further to 29.5 per 1,000 live births. This is compared to regional data which shows the under-five mortality rate is 82 deaths per 1,000 live births.
• We are in the midst of conducting a robust evaluation of our program expansion. This quasi-experimental study employs repetitive cross-sectional surveys to understand health impacts in Lwala sites compared to control sites. The study focuses on maternal and child health, but also collects a wide range of socio-economic data to help us understand more about the drivers of health outcomes.

Administration and Management

• In February, we attended the Sankalp Africa Forum to meet with current partners, including Geo Gecko and Dimagi, to discuss and pilot potential tools for M&E.
• In March, we attended Innovations in Healthcare as a second-year member of the global cohort to foster our relationship with the network while opening up channels of engagement with Pfizer, a board member and investor of IIH.
• In April, Skoll World Forum was an opportunity to steward relationships with over 20 current or potential partnerships through 1:1 meetings, session participation, and social activities. We discussed potential proposals and were invited to submit to 5 partners and forged relationships with 7 potential partners.
• Unite for Sight resulted in engagement with the broader global health community on responsible fundraising, leadership, and ethical development.
• As a member of Community Health Impact Coalition (CHIC), we attended a UN General Assembly (UNGA) meeting on Universal Health Coverage.
• Looking ahead to Q2, we plan to participate at Izumi, Women Deliver Global Conference, and the Aspen Ideas Festival.

Success Story

Winnie Onyango

Winnie Onyango’s baby, Berverline, was diagnosed with malnutrition in September 2018. Winnie noticed that her baby was small and that she seemed very tired. At her friend’s suggestion, she brought Beverline to Lwala Community Hospital for treatment. They were brought to the nutritionist, Nancy, who conducted a full evaluation. Nancy took a Mid-Upper Arm Circumference (MUAC) reading, which is a very simple way to assess a child’s weight compared to their height.

Beverline’s MUAC was 10.7 cm, which indicates severe acute malnutrition. Beverline was admitted to Lwala Community Hospital for four days, where she was given supervised feedings and nutritional support from our clinical and nutrition teams. Winnie and Beverline were enrolled in counseling and our mother-care peer groups, where they received nutrition education and psychosocial support. Finally, they were discharged with supplements and therapeutic feeds to support weight gain.

When Winnie and Beverline returned two weeks later, the baby showed signs of improvement and was more alert due to increased micronutrient intake. Winnie was enrolled in agronomy training and given spinach seeds, pumpkin seeds, and squash seeds so that she could start a kitchen garden. Winnie is a farmer and sells her crops as her economic means, but she had not known how important a diverse diet is for a baby until she joined the nutrition program. Now, Beverline has a MUAC reading of 14.5 cm, which is healthy and normal.

“I really appreciate the nutritionist, Nancy, who gave us supplements and counseling, and I encouraged another mother with a very small baby to come receive the same support,” Winnie said.