Kenya: Lwala Healthcare Project
Improved and Sustained Positive Health-Seeking Behavior: Q1 2017
May 31, 2017
Summary of Activities
Lwala Community Alliance (LCA) is a community-led, nonprofit health and development innovator working in Migori County in rural western Kenya. Through Lwala Community Hospital, the organization provides approximately 50,000 patient visits each year. The mission of the organization is to build the capacity of the people of North Kamagambo, including its neediest residents, to advance their own comprehensive well-being. The hospital is part of a larger effort to achieve holistic development in Lwala and the surrounding community, including educational and economic development.
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 antimalarials), 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.
During this quarter RMF funded maternal and child health costs including:
- Personnel costs for nurses Rose Gayo and Caren Siele
- 58% of medicine costs
Comprehensive Health Care
- The hospital saw increased patient numbers during the quarter compared to the same period last year (12,022 patients in the first quarter of 2017 versus 10,140 patients in the first quarter of 2016), likely heightened by a nationwide doctors’ strike.
- Lwala sustained a 98% skilled delivery rate for all mothers in the catchment area and 96% prevention of mother-to-child transmission of HIV.
- In 2017 to date, the team has achieved a contraceptive uptake of 2,436 couple years of protection (CYP), a 139% increase from the first quarter of 2016. Couple years of protection is a measure that weighs the value of a contraceptive method by the number of years it provides protection from pregnancy. At this current rate, we expect to exceed our target of 6,000 CYP by the end of 2017.
Improved Educational Results
- The preliminary findings of a research study on the e-reader program show a 19% improvement in literacy in program participants compared to the control group. A similar study was started for our new library model launched in 2017 to determine if the same literacy outcomes can be achieved at a lower cost per student.
- Lwala remodeled the program’s sexual and reproductive health curriculum, intensifying lessons on family planning, abstinence, and condom use to decrease teen pregnancy rates.
Public Health Program
Sustained Health-Seeking Behavior
- Lwala successfully exceeded its target of enrolling 5,000 children in the maternal and child health community program, reaching a total of 5,338 children by the end of March.
- An intensive community-led total sanitation (CLTS) training initiative was launched during the quarter, reaching 54 community members. Participants learned about the consequences of poor sanitation and benefits of latrine construction, practicing how to support neighbors in latrine construction. As a result, 90 new latrines have been constructed so far in 2017.
- Lwala has continued to exceed its target of fully immunizing 90% of children under 5, maintaining a quarterly rate of 96, which is significantly higher than the county rate of 47 (DHIS 2014).
Economic Development Program
- After a successful 6-year partnership with the Development in Gardening Program, the gardening-based nutrition program was handed off to Lwala Community Alliance. The Lwala team is now working to fully integrate nutrition programs into our community health and clinical model. The team has enrolled 300 children and 58 HIV-positive clients in the program.
- Lwala supported a new partner organization, Village Enterprise, in its first round of a targeting process to identify over 400 eligible program participants. The selected participants will receive in-depth training to start and grow small businesses.
Monitoring and Evaluation
Data Collection and Management
- A mobile-based, community-wide household survey was completed in early 2017. Analysis is ongoing to further understand population-based information across our catchment area, such as health-seeking behavior and HIV stigma.
- Development of a new community health worker (CHW) case management application has continued throughout the quarter. The application is designed to help workers monitor patients, ease data entry, improve referral tracking, and provide faster programmatic feedback. The application is expected to launch with a pilot group in the second quarter of 2017.
Administration and Management
10-Year Anniversary Gala
- We held a 10-year anniversary gala to celebrate Lwala Community Alliance’s “Decade of Impact” and raised approximately $200,000.
- Community Health Nurse Obel Elkana has been promoted to Clinical Mentor. He will serve as the trainer for all new clinical staff and oversee the clinical improvement strategy.
- The Kenyan audit was completed in March, receiving an unqualified opinion from the auditors.
- In the US, a new executive assistant and engagement officer were hired and onboarded. Both team members are performing at a high level.
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.
- Improve patient care and clinical operations
- Improve access and facility infrastructure
- Expand and improve quality of education programs
- Professionalize the organization through better policies and practices
- Properly procure and account for physical, financial, and human resources
- Increase impact of health outreach programs
- Build capacity of community members in income generating activities
- Improve programs through better communication and monitoring and evaluation
Coming to Terms with His New HIV Status
Evans is a married, middle-aged man with two children. After getting sick, he visited RMF-supported Lwala Community Hospital, where he was tested and counseled on his HIV-positive diagnosis. Despite this diagnosis, Evans refused to believe that he had contracted HIV. After his condition deteriorated, he visited the hospital for further testing. Still ignoring the clinician’s recommendation, Evans requested to be discharged and refused to enroll in antiretroviral therapy.
One day at home, Evans heard loud music from a nearby market. He was too weak to go to the event but could hear fellow community members talking about HIV, telling their stories about how they overcame fear and stigma to seek treatment. Evans thought about his own fear, especially about what his wife and children would think—would they disown him? He never thought that HIV would be a battle he would have to fight. As Evans continued to listen, he asked his son to tell the event organizers that he would like to speak with them.
Evans learned about the HIV and WASH Integration (HAWI) program through a community health worker who had helped mobilize the community for the event. Evans joined the program willingly, after hearing such positive feedback from his community members. The community health workers and clinical staff worked together to help Evans disclose the diagnosis to his partner, always available to provide support as needed. He says,
“I thank God for the step I made to visit the Lwala Community Hospital almost two months ago and for my wife’s acceptance of my new HIV status. I now live stronger and healthy, free from illnesses that previously affected me. They do not haunt me anymore.” He continues, “However, it hurts me to think of the wasted resources during my denial period. If I could turn back the hands of time, I would have disclosed my status to my family members much earlier and probably protected the family from wasting their time and resources.”
Since enrolling in the HAWI program, Evans has regained his strength and now works in his kitchen garden. His wife and the community health worker ensure that Evans adheres to his daily antiretroviral treatment. Their family lives close to Lwala Community Hospital, and Evans looks forward to regular clinical appointments and medication refills. The positive impact that HAWI has had on his life inspired him to become an advocate in the community. Evans supports community members who are in denial of their HIV status and encourages everyone to seek care.
Vera Awuor Onuko
Better Breaks Program
Vera Awuor Onuko is a 13-year-old girl attending Tuk Jowi Primary School. As a young girl living within the North Kamagambo region, she is vulnerable to teen pregnancy, sexual and gender-based violence, and sexually transmitted infections. Over holiday breaks, this risk increases, as the youth have more opportunities to engage in sexual activities outside of a nurturing school environment.
Vera feared this heightened pressure, unsure how to confidently say “No.” To learn how to protect herself, she attended RMF-supported Lwala Community Alliance’s Better Breaks program. Over one week during the holiday break, mentors educated Vera and other pupils on sexual and reproductive health and self-agency to build confidence and reduce risky behavior. Applying these tools, Vera now uses assertive eye contact and communication to resist pressure to date boys. She recognizes her own self-worth and rights as a young girl, intending to build positive relationships that do not endanger her well-being. Vera no longer feels threatened by teen pregnancy and is confident she will continue her education, using stress management and goal setting to achieve in school.
In her words,
“I am so happy that I have improved my education. I now have confidence to talk before people and even recited a poem in front of the whole group. Though I now feel safe from becoming pregnant, other girls may not. I want all youths to attend Better Breaks to learn how to abstain and stay in school.”
With this knowledge, she believes that teen pregnancy, early marriage, and school dropout can be avoided. Vera is excited to participate in future Better Breaks programs and vows to spread this knowledge to her peers to better their lives.