Kenya: Lwala Healthcare Project
Patient Numbers at an All-Time High: Q4 2016
February 18, 2017
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 antimalarials), HIV testing and care, public health outreach, and safe maternity.
During this quarter RMF funded maternal and child health costs including:
- Personnel costs for nurses Rose Gayo and Caren Siele
- 58% of medicine costs
Access to Quality Health Care
- 2016 patient numbers were at an all-time high at 46,769, which is a 53% increase from 2015.
- Lwala sustained a 97% skilled delivery rate for all mothers in the catchment area and 95% prevention of mother-to-child transmission of HIV.
- Contraceptive uptake reached an all-time high of 5,771 couple years of protection (CYP) during the year. 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.
Public Health Program
Positive Health-Seeking Behaviors
- Lwala successfully reached its target of enrolling 5,000 children in the maternal and child health community program, reaching a total of 5,070 children by the end of December.
- The pilot phase of a mobile data collection program was rolled out during the quarter, training 29 community health workers to use electronic tablets for data collection in the Thrive Thru 5 and HIV community program.
Improved Exam Scores and Literacy
- The preliminary findings of a research study on the e-reader program implemented at three primary schools in the region show encouraging results that e-readers are improving literacy.
- The average standardized primary school completion exam scores from across all primary schools rebounded to their 2014 levels at 241 out of a total 500.
Economic Development Program
Partnering Locally to End Poverty
- The management of the Development in Gardening Program has been officially handed over to Lwala Community Alliance. The economic development staff at Lwala will lead the agriculture and nutrition program throughout the community, with plans to reach the most vulnerable households.
- An official partnership with Village Enterprise is underway, in which local entrepreneurs are provided in-depth training to start and grow small businesses. Village Enterprise is a nonprofit operating in Kenya that is dedicated to ending extreme poverty in rural Africa through entrepreneurship and innovation.
Monitoring and Evaluation
Initiating Great Improvements
- The M&E team hired a database administrator, Anthony Maina, who brings expertise in Salesforce and has already shown great initiative in improving the data systems at Lwala across the board.
- Plans for a community-wide household survey were made during the quarter, when Lwala Community Alliance received ethics board approval in Kenya and developed the survey questionnaire in CommCare, a mobile application that will ensure high-quality data and a faster data collection process overall. The survey will be carried out in January 2017.
Operations and Finance
Managing Daily Functions
- A joint Kenya-US finance policy was developed and approved, ensuring that policies and procedures are clearly laid out to be followed and monitored on an ongoing basis.
- The earned revenue from patient fees at Lwala Community Hospital increased from $37,000 in 2015 to $48,000 in 2016, now covering 14% of the hospital budget.
- Hillary Omolo, the new Health System Strengthening Partnerships Manager began his tenure at Lwala Community Alliance in December.
- Lwala received approval for the National Health Insurance Fund in Kenya, which should lead to a new source of revenue in 2017.
- A gender equity committee was established in the Kenyan office to encourage equity and handle cases of inequity brought forward by staff.
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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2016 patient numbers were at an all-time high at 46,769, which is a 53% increase from 2015
Approximately 35,000. The total population of North Kamagambo is 16,500, and programs are a magnet to people beyond North Kamagambo.
Mary is a married woman with two children. In 2004, Mary experienced fevers and generalized weakness from a chronic illness that hindered her life and livelihood. She lacked the energy to work and socialize, remaining indoors unable to walk. When Mary finally found the courage to visit a hospital, she tested positive for HIV. Despite adhering to her antiretroviral treatment, Mary remained underweight at a feeble 40 kilograms and felt discouraged without the support of her husband, to whom she feared disclosing her status.
In March 2016, a community health worker (CHW) visited Mary and enrolled her in the HIV and WASH integration program. During household visits, Mary learned about WASH, nutrition, and HIV management. Through this training, she realized just how vital nutrition is when on HIV care. Over several months, Mary slowly gained back weight and found her strength again. She regularly attends Lwala’s outreach events to hear success stories from others on HIV care. Their willingness to share helps her overcome her own fear of openly acknowledging a positive status. Having received such effective support from the frequent visits of a community health worker, Mary felt empowered to encourage fellow community members to know their own status.
Applying her newfound skills, Mary counseled her husband, who tested positive and enrolled in care. Mary no longer hides her drugs in shame and actively promotes support group opportunities within her household. She maintains a new kitchen garden with a variety of fresh vegetables and is back to completing daily work. Mary is grateful to the HAWI program for providing care to vulnerable HIV-positive community members.
Mito Gordon Osinda
Mito Gordon Osinda attends Minyenya Secondary School. Orphaned at age 9, he struggled to focus in school while managing his HIV-positive status. As a distraction from his troubles, Mito often found himself near the gold mines in his area, surrounded by violent men engaging in heavy alcohol use and risky behavior. Avoiding peer pressure to participate became increasingly challenging.
Over a school holiday break in 2016, Mito attended Better Breaks, a weeklong program offered by Lwala Community Alliance. With pupils from the entire North Kamagambo region, he learned how to deal with peer influence, anger, and conflict. His Better Breaks mentors helped him recognize how the mining environment could endanger his health and safety. To resist this peer pressure, Mito now applies assertive strategies to make better, more confident decisions. The program inspired him to work hard in school, improve his behavior, and build quality, supportive friendships.
Outside of Mito’s personal growth, Better Breaks continues to impact his life. After failing in school, Mito’s brother contemplated suicide. Mito mimicked his Better Breaks mentors, encouraging his brother to appreciate and value his life. He recalls this event: “I wanted to help my brother as Better Breaks helped me. I continued to talk to him about how his life is so important and not dependent on test scores. Slowly he started to see that his life mattered and was motivated to do better. He’s now among the top in his class.” Similar to how Mito helped his brother, he hopes to continue applying this knowledge to improve his community, sharing ideas among pupils from other schools in future programs. Mito is grateful for his experience at Better Breaks and encourages all youth to participate to better their lives.