Kenya: Lwala Healthcare Project
Hospital Registered with Medical and Practitioners Board: Q2 2016
October 27, 2016
Summary of Activities
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.
Increased Patient Numbers
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.
Public Health Program
Testing and Treatment of Malaria
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.
Economic Development Program
Partnership with Village Enterprise
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.
Monitoring and Evaluation
Second Best Health Facility
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.
Administration and Management
Operations and Finance
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.
- 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
During the reporting period, 12,971 patients were served at Lwala Community Hospital.
Approximately 30,000. The total population of North Kamagambo is about 16,500, and programs are a magnet to people beyond North Kamagambo.
Table Banking Empowers Impoverished Youths to Reach Their Goals
In North Kamagambo, young people face great challenges. Increased poverty, unemployment, and food insecurity inhibit their livelihoods. To address this, a group of young people formed the Nyachuria Youth Group to kick-start income generation. Despite their efforts, low savings and inadequate financial knowledge led to a loss in members and morale.
Determined to succeed, the Nyachuria Youth Group partnered with Lwala Community Alliance’s economic development team. The economic development team works with over 13 groups in the community to improve economic practices through training and mentoring. After completing modules on table banking and financial literacy, the young people started to adopt better practices. The economic team continued to link them with other successful groups, serving as a source of empowerment and encouragement. With new knowledge and exposure to the savings culture, the Nyachuria Youth Group was able to properly provide loans to its members, and members were empowered to repay those loans.
Paul, the group’s chairperson, reported, “A number of members have observed a drastic change in life. Through the table banking processes learned, group members can now afford to pay school fees and are able to expand their businesses with ease.” In addition to individual successes, several group income generating activities, including cereal banking and poultry keeping, were initiated from the interest earned on successful loans. Further funds enabled the group to invest in a public address system, an additional source of employment through loaning the system to the community.
With guidance from Lwala Community Alliance, the Nyachuria Youth Group has saved $1,000 from income generating activities alone. When the group shared out earlier this year, an individual member could receive up to $300. Their commitment has led Nyachuria Youth Group to be one of the community’s most successful table banking groups. The economic development program continues to reach over 200 individuals, facilitating table banking processes to improve community livelihoods.
Maurice Otieno Ochieng
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.