Kenya: Lwala Healthcare Project
Lwala Community Hospital Report First Quarter, 2014
July 31, 2014
Katherine Falk and Jonathan White
Summary of Activities
- Funded maternal and child health costs including:
- Personnel costs for Nurses Rose Gayo and Geoffrey Orangi and Nurse Aid Rosemary Akello
- 58% of medicine costs
- Funded ambulance repairs and maintenance
- Funded fuel for ambulance to provide emergency transportation
- Funded obstetric emergency referrals
Care & Counseling
10 support groups formed (up to 250 members now), ARV training for 5 staff, and an increase in defaulter tracing activities
Average monthly deliveries at the Lwala Community Hospital was 38 in Q1.
Improved patient care and clinical operations
Increasing patient numbers
Average total monthly patient numbers increased by 22% (3,379 in Q1 from 2,752 the previous quarter). This is the highest monthly average to date.
Improved access and facility infrastructure
Supplies procured and plans finalized
New wireless internet connectivity was established in January. Staff members now enjoy the benefits of improved communication mechanisms.
Final revisions were made for hospital expansion designs – Phase II (connecting wing) and Phase III (ward) and staff housing. Tendering and bidding process is expected to begin in April, and construction is expected to start in June. The Youth Friendly Corner site was identified; negotiations are under way to secure the site. Two new microscopes for the lab were purchased. New computers were procured in preparation for electronic medical record (EMR) implementation.
Expand and improve quality
- Implementation started on Youth Peer Provider (YPP) year 2 activities. Key activities include continuation of YPP-led school clubs, peer-to-peer sexual and reproductive health education, parent and community sensitization, and condom distribution to youth.
- 360 schoolgirls received uniforms made by New Visions women. 461 parents attended uniform distribution ceremonies.
- The girls mentoring program has continued weekly meetings with in-school girls and out-of-school girls (36 in-school girls and 57 out-of-school girls).
- 50 in-school YPPs continue to participate and help facilitate monthly school clubs. HIV information was added to club topics. However, not all clubs are utilizing the curriculum or meeting regularly. Quality improvement and follow-up needed.
- 10 new students were selected for secondary school sponsorship through partnerships with Kenya Education Fund (KEF) and Education for All Children (EFAC).
Income generating activities
Build capacity of community members
- 2 new school gardens were implemented (bringing the total to 5) as part of a research study project to measure the impact of school gardens on student nutrition and cognitive function.
- The New Vision Women’s Sewing Cooperative manufactured school uniforms in 2013, and all uniforms were distributed in Q1 of 2014.
- The New Vision women worked on enhanced pad kits for local schoolgirls. The kits include a set of 5 reusable sanitary pads, several pairs of underwear, soap, and sexual/reproductive health information. All materials are procured; distribution is planned for Q2.
- The New Vision Sewing Cooperative, the Furaha Soap Making Cooperative, and various youth groups continue to meet monthly and strategize to improve sales and product offerings. Currently there are 6 active youth groups.
- Lwala Community Alliance’s partnership with KIVA on micro-lending to members has continued to grow in the community. 28 community members are currently receiving micro-loans through KIVA. The defaulting rate decreased from 30% to 0% by the end of Q1. The repayment rate is currently 94%.
- The New Vision women manufactured backpack prototypes as part of a new initiative with BD.
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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Thrive thru 5” Expands Successful Outreach Program to Reach Children under 5
In February 2014, Lwala Community Alliance launched a program called Thrive thru 5 to extend clinical services and community outreach efforts to children up to age 5 in order to reduce under-5 mortality in the community by 50% over the next 3 years. To accomplish this, Lwala Community Alliance is committed to ensuring that babies are born safely and protecting growing children from the most common regional threats of mortality: malaria, HIV, diarrhea, pneumonia, measles, injury, and malnutrition.
Through the success of the Safe Babies program launched in 2012, early infant death in the Lwala area has been cut in half (from 60:1000 to 31:1000). The most notable driver in this success is the rate of facility-based delivery, which increased from 26% of pregnant women in 2010 to 96% in 2013. With the support of partners, Lwala Community Alliance expanded the facility and trained and deployed community health workers (CHWs) to recruit pregnant women into prenatal care, facility-based delivery, newborn care, and infant immunizations. However, extending care past infancy is essential in sub-Saharan Africa, which accounts for half of the world’s under-5 mortality.
Thrive thru 5 will extend the current outreach conducted to pregnant women and neonates to now reach all children up to age 5. Specifically, Thrive thru 5 will ensure that 98% of pregnant women access prenatal care and deliver in a health facility, 100% of newborns receive care after delivery, 90% of children under 12 months are fully immunized, 7,000 children under 5 have access to affordable primary care, and local health workers are leading the effort.
Malaria Outbreak Prompts Swift Response
During the wet seasons in Lwala, bushes grow quickly, and pools of stagnant water collect around the homes – both risk factors that can lead to an increased prevalence of mosquitos in the community. For these reasons, heavy rains in the first quarter of 2014 resulted in a sharp rise in malaria admissions and mortalities, with 21 under-5 deaths attributed to malaria. Through the provision of affordable treatment for under-5 children and anti-malarial medications, the Lwala Community Hospital treated over 1,000 children for malaria in the first quarter.
In addition, a team of more than 50 Community Health Workers were mobilized to conduct outreach to families in the community to distribute insecticide treated mosquito nets (ITNs) and disseminate health messages on the proper usage of ITNs, the importance of clearing of bushes around the homes and covering open ditches where mosquitos breed, and the need for early referrals of sick people to the hospital to reduce the severity of malaria. From January to March, a total of 144 ITNs were distributed to households with under-5 children. Lwala Community Alliance clinicians and Community Health Workers also conducted a community dialogue day to bring together community members, opinion leaders, and government officials to discuss the planning and execution of action plans geared towards malaria prevention.
Continued collaboration with stakeholders (e.g., the government and the local community) will aim to bolster prevention practices and reduce ongoing cases of malaria.