Kenya: Lwala Healthcare Project
502 Girls Enrolled in Mentoring Groups: Q2 2018
August 24, 2018
Summary of Activities
Through Lwala Community Hospital, the Lwala Community Alliance 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.
RMF-supported LCA completed the following activities:
- The first Better Breaks session included sex education and a video screening on the dangers of cross-generational sex, which parallels the Young Love curriculum we are rolling out at health clubs. The program reached 503 young people.
- In 2017, we conducted a household survey measuring population-based information across Lwala-supported communities, with the support of Vanderbilt Institute of Global Health.
- Initial key findings from the household survey include: Under-5 mortality rate is 29.5/1,000 live births over the last five years, a 64% reduction compared to the Nyanza (regional) average. Contraceptive prevalence rate is 61.5% compared to 44.6% in Migori County.
- RMF funded maternal and child health costs including:
- Personnel costs for nurse Rose Gayo and clinician Wycliffe Omwanda
- 58% of *medicine costs
- The primary beneficiaries of RMF-supported Lwala Community Alliance are children, women, HIV-infected persons, and the elderly.
Youth Mentoring Groups
Building Confidence and Avoiding Risks
In June 2018, 385 in-school girls and 117 out-of-school girls were enrolled in our mentoring groups. These groups teach girls about self-confidence and the skills to avoid risky behaviors. As of June 2018, 177 female students and 143 male students were trained on our Young Love curriculum. The curriculum aims to teach students about the risks of inter-generational relationships as they relate to teen pregnancy and HIV.
The eMTCT Program
Preventing HIV in Infants
In 2017, only one child in the eMTCT program turned HIV- positive, and we are striving to outdo this performance by achieving a 100% eMTCT rate in 2018. We are on track to achieve this goal, with 84 HIV-exposed infants reaching 18 months and testing negative so far in 2018.
Partnering with Village Enterprise
Training and Entrepreneurship
In order to provide financial access to even the most impoverished community members, Lwala continues to partner with the organization Village Enterprise. Village Enterprise provides training and microgrants to community members so that they can start their own small businesses. The 485 individuals who were identified in the Progress Out of Poverty Index were enrolled in Village Enterprise programs. Training for this cohort began in April, and they received their grant disbursements in June.
Understanding Health Outcomes
We are also in the midst of conducting a robust evaluation of our program expansion. This quasi-experimental study employs a stepped-wedge, cross-sectional design to understand health impacts in Lwala sites compared to control sites. The study focuses on maternal and child health outcomes, but also collects a wide range of socioeconomic data to help us understand more about the drivers of health outcomes. We have already surveyed 1,100 households across our current innovation hub and primary expansion location. The step wedge design allows us to repeat the survey every 12–24 months in new locations as we grow.
Saving New Mothers
Partners from the University of California, San Francisco trained clinicians from Lwala and nearby partner facilities on the non-pneumatic anti-shock garment (NASG), a low-cost tool used to prevent women from experiencing post-partum hemorrhage after delivery which has been used 8 times in our facilities.
Providing Access to Health Care and Testing
Measuring Success of Contraception
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. We have provided 4,883 couple years of protection (CYP) which is a measure that weighs the value of a contraceptive method by the number of years it provides protection from pregnancy.
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
Patient to Advocate
Over the last ten years, Olivia has grown from a Lwala patient to one of our strongest advocates. Olivia first visited Lwala Community Hospital in 2008 for a check-up. Her husband had passed away four years previously, and she was beginning to experience some of the same symptoms he had experienced before his death. When the lab technologist explained that Olivia had HIV and would need to be enrolled for treatment, she immediately accepted her diagnosis and began taking antiretrovirals. Her attitude towards her HIV diagnosis was reflective of her attitude towards other challenges in life: to face it head-on.
Olivia consistently took her HIV medication and joined a Lwala HIV support group called Tang’chon, meaning “prepare in advance.” With her HIV under control, Olivia decided to take on a new challenge, pregnancy. She enrolled in Lwala’s Thrive Thru 5 program and joined the elimination of Mother-to-Child Transmission (eMTCT) of HIV cohort. Through these programs, she was supported by Lwala Community Health Workers Elizabeth and Carolyn and was treated with highly active antiretroviral therapy (HAART) to ensure that her viral load would remain low throughout the pregnancy. In September of 2015, she gave birth to a healthy baby boy named Wallace. In accordance with eMTCT protocol, Wallace was consistently tested for HIV until he could be definitively declared HIV-negative at 18 months. To ensure that Wallace remained healthy, Olivia diligently brought him to the facility for his well-child visits and immunizations.
In February of 2017, the Lwala nutrition facilitators conducted a community screening to identify anyone who was at risk for malnutrition. Though Wallace was developing normally, he was identified as at risk because his mother was HIV positive. Olivia and Wallace were then enrolled in the nutrition program, and Olivia began attending trainings. She quickly embraced the lessons from the nutrition trainings and started a kitchen garden at home. After seeing the benefits of growing her own food and using her land efficiently, she hoped to expand the garden into a larger farm.
It is now over a year since Olivia was enrolled in the nutrition program, and her land is thriving. Next to her house she is growing spinach, butternut squash, coriander, capsicum, beetroot, onions, and some indigenous vegetables. In addition, she has used the money from selling her extra crops to purchase two sheep and a small potato farm that she is using purely for commercial agriculture. According to our
nutrition survey conducted in November 2017, Olivia has the highest producing farm out of all the nutrition clients that Lwala works with. She takes pride in her work, stating:
"Lwala has really helped me by keeping me healthy and providing me with the tools to take care of my children and keep them healthy too. Lwala has taught me about nutrition, which allows me to have a healthy family, and that is the most important."
In her free time, Olivia likes to encourage her friends to adopt kitchen gardens and give them advice when they grow new crops. She is using the profits from her farm to pay for her children’s school fees and is looking forward to adding maize to her standard rotation of crops in order to increase her profits. Through a decade of partnership with Lwala, Olivia has faced every challenge with grace and is creating a large impact in her own community as an advocate and friend.