Kenya: Lwala Healthcare Project

Lwala Community Hospital, Q2 2015: Rainboots and coats Improve Defaulter Rates

October 13, 2015

Katherine Falk & Liz Chamberlain

Summary of Activities

Funded maternal and child health costs including:
o Personnel costs for nurses Rose Gayo and Vincent Onsongo
o 58% of medicine costs
o Funded obstetric emergency referrals
o Funded miscellaneous additional needs

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Results &


Hospital Program

Sustained reduction in morbidity and mortality

Quality of care throughout the hospital has improved; there is a working infection control committee, an increased number of case reviews, and intensified defaulter tracing for HIV clients and pediatric immunization clients.

Public Health Program

Improved and sustained positive health-seeking behavior

Targeted sanitation outreach by the WASH team has resulted in 103 new latrines were constructed during the quarter in 10 villages

Education Program

Improved graduation rates, education results and health outcomes

Better Breaks, a week-long camp during school breaks, launched in April and attracted 615 adolescents to learn about sexual and reproductive health.

Economic Development Program

Increased economic opportunities

DIG activities in North Kamagambo have been strengthened in 2015, with three farmer groups in the area completing training in May and three additional beginning training in June.

watertower view of new hospital connecting wing

Hospital Expansion Project

Almost Complete

Minimal surface work still outstanding. Renovation of the existing hospital will begin in July, so some clinical services will shift to the new connecting wing at that time.

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& Objectives


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
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Click to enlarge

Real Medicine Foundation - more photos.
Real Medicine Foundation - more photos.
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Q2, 2015

2,786 patient visits for reporting period

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Construction of the main hospital connecting wing is nearing completion

Clinical services will begin shifting to this wing at the end of July. The existing hospital renovation will take place during August and September, at the same time the new staff housing moves toward completion. An official opening and ribbon-cutting ceremony is scheduled to take place on November 2. Because of a slight delay in project activities, LCA’s Operations Team and LCA management are actively working with the contractor to move the progress forward in order to catch up to the original timeline. Major achievements in the reporting period include the following:

• The interior and exterior walls were plastered and painted, floors were tiled, fixtures and furniture were installed, and electricity was wired throughout the building.
• Construction of the walls for the staff housing has been completed, and the land around the buildings was leveled.
• An equipment vendor was competitively selected, and an initial equipment order was placed in June. Additional equipment will be ordered in July and August.

Defaulter Tracing at Lwala Community Alliance

Assessing patient data collected over recent years, LCA clinical staff noted a steady increase in defaulter rates during the rainy season. Inclement weather and poor road quality during this period made it exceedingly difficult for beneficiaries to attend their scheduled clinical appointments and treatments. As a result, many clients were not accessing the medical, psychosocial, and nutritional services provided by LCA, and poor adherence to medication during this time contributed to most treatment failures recorded.

In an effort to reverse this trend, this season the LCA defaulter tracing team and entire patient support center (PSC) devised a long-term method of dealing with the problem at the local level. To encourage treatment adherence, the team shifted their approach, instead deciding to meet clients at their own homes for home assessment, psychosocial support, adherence counseling, and medical and nutritional services. Despite challenges including harsh weather and poor roads, the PSC staff remained flexible and determined to serve their clients in the most effective way possible. Even simple solutions like rain boots and rain jackets helped in ensuring the staff can get where they need to go.

Ultimately, this initiative has been an integral part in lowering defaulter rates among LCA beneficiaries. Through their own persistence and neighborliness, the PSC staff has conveyed to their clients the importance of good drug adherence and attendance at the clinic as scheduled. These changes in patient care have led to improved outcomes and have helped maintain standards of health during the rainy season in Lwala. The Njura Women’s Support Group is a group of 40 widows living with HIV/AIDS in North Kamagambo who meet every Friday afternoon. The group was started in 2013 by a few widows who felt neglected, abandoned, separated, and stigmatized by the community because of their HIV status. The widows were seeking medication from different health facilities in order to avoid being known as HIV+.


Emily is 22 years old and a member of the Salama Pamoja mentoring program. She lives with her husband, who is both a peasant farmer and a community health worker in the village of Kadianga. She also has two young children, ages 5 and 2.

Emily’s father died when she was very young, forcing her single mother to raise all six sons and eight daughters by herself. Growing up in a family of 14 children, Emily is no stranger to poverty and the burden it has on people. In fact, she is the only member in her family to finish high school. In the face of such difficulty, she still managed to get a passing grade while holding several odd jobs to pay off her school fees. However, despite finishing high school, she could not continue her education since she had no sustainable financial support. As a result, Emily married at the young age of 17.

Earlier this year, Emily joined Salama Pamoja’s out-of-school girls mentoring program. With the guidance of trained mentors, she learned about family planning and the importance of child spacing. After learning about maternal and child health, Emily decided to have only three children, whom she can properly care for and nurture. She also learned how to be a better parent. Like many other mothers in Kenya, Emily would often leave her 5-year-old child to watch the younger sibling while she attended to housework. However, since the program, she has learned the importance of proper parenting and supervision.

Through the support of her mentors, Emily has also grown in confidence and self-esteem. She learned to voice her thoughts more effectively to her family. Before, she was too timid to speak to her husband, but now she is able to sit down with her husband to discuss different issues including family planning. She and her husband are communicating more effectively and making decisions together, strengthening their relationship.

With newfound self-esteem, Emily made a decision in April to further her education by going to college to study early child development (ECD). In college, she found a new dream of becoming an educator and is now working part-time as an ECD teacher at Kadianga Primary School to earn money to continue to pay for college. She also wants to learn how to make soap so she can continue to finance her own education and have financial stability. Emily found her independence as a woman as she strives to better her and her family’s future. Through Salama Pamoja, Emily has learned not only to respect herself but also gained the respect of her family and her community.

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