Kenya: Lwala Community Health Center year end report
February 18, 2011
James Nardella and Katherine Falk
The Ochieng’ Memorial Lwala Community Health Center is a community-based project that is managed and supported in partnership with the Lwala Community Alliance, a U.S. based humanitarian organization. The mission of the clinic is to meet the holistic health needs of all members of the Lwala Community, including its poorest. Whenever possible it addresses health problems at their roots through community health interventions. It aims to provide excellent community-based health care, not to become a tertiary care facility. The health center is part of a larger effort to achieve holistic health and development in Lwala, including educational and economic development.
Project Objectives during this reporting period:
1. Actively engage the community through preventative health education and education programs to regain patient numbers at the health center
- Hold monthly Hygiene and Sanitation trainings
- Hold monthly Umama Salama courses
- Conduct consistent weekly outreach by clinic staff
- Host Children’s Club every month
- Institute new Girls School Uniform Program
2. Continue Capacity Expansion
- Keep new build on time, budget
- Hire more clinical and outreach staff
3. Improve operating systems for better accountability
- Adhere to accounting protocol established in August
- Implement new patient record system
4. Increase enrollment of patients in HIV Care
Summary of RMF-sponsored activities carried out during the reporting period under each project objective (note any changes from original plans):
- Paid salary and other employment costs for Clinical Officer John Badia
- Paid for maternal and child health costs including:
- Salary and other employment costs for maternity nurse Rose Adhiambo Gayo
- Safe Motherhood (Umama Salama) Community Education Program
- 53% of medicine costs
- Paid for ambulance repairs and maintenance
- Paid for fuel for ambulance to provide emergency transportation
- Paid for obstetric emergency referrals
Results and/or accomplishments achieved during this reporting period:
- Preventative Health and Education Outreach
- Hygiene and Sanitation trainings have been held each month since May, with very good attendance and follow up. WASH Coordinator Elizabeth Akinyi is excellent with extensive experience.
- 3 day Umama Salama courses for life saving skills for mothers during labor have been going on every month with good attendance.
- Education outreach involved input from 18 stakeholder groups at 4 schools
- Consistent weekly outreach by clinic staff began in earnest in November 2010 (HIV testing, de-worming, Vitamin A supplements, referrals for Antenatal Care, Family Planning, vaccinations). Approximately 60 people served per outreach, 3 times/week. Mobilized patients to return to the clinic as well.
- New flat fee for children under 5 was also instituted in December 2010 and patient numbers have begun to correct significantly (a total of 1,269 in January 2011)
- Children’s Club conducted every month with more than 50 children in attendance each session
- Girls School Uniform Program supplied 400 uniforms and 400 sets of menstrual pads to incentivize primary school completion to girls in class 6-8.
- 10 secondary school scholarships being awarded to class 9 students for 2011
- 3 students are currently receiving higher education support for medical education from LCA
- By December, the new maternity and private consultation wing were at level of roofing, with expected completion by mid-March 2011
- Hired new second clinical officer Fredrick Morara, new nurse Teresa Atandi, and received third clinical officer from FACES Sylvia Kwamboka
- Due to new programs and building projects, Lwala Community Alliance employed over 60 people in 2010 – 14 clinical staff, 9 operations staff, 3 administrative support, 2 education staff, 1 director, 8 sewing co-op members, and more than 24 workers building the maternity and HIV consultation wing.
- New protocol for Kenya financials established and adhered to since August
- Greater local accountability: Local community leadership has met with Kenyan staff every month since June 2010 to approve budget for upcoming month and review actuals from previous month.
- Successful implementation of a new health record booklet for outpatients. Follow-up to be conducted by Vanderbilt PhD student in the spring of 2011.
- FACES partnership for HIV looks solid for another 5 years
- Nearly 650 people are currently on HIV care or treatment
- Smaller successful ongoing partnerships with IMPACT and Marie Stopes to provide family planning and male circumcisions
Number served/number of direct project beneficiaries (for example, average number treated per day or per month and if possible, per health condition).
Notable project challenges and obstacles:
There are three challenges that were faced during the reporting period.
The most notable challenge related to RMF sponsored activities is the rapid deterioration of the ambulance through aging and wear and tear. The 18 year-old vehicle is now experiencing unsustainable maintenance needs. Due to its age, the auto insurance company has recently refused to fully insure it beyond third party liability. Because of daily driving on unpaved dirt roads near Lwala, the vehicle has encountered a dangerous new malfunction- its wheels periodically fall off during transport. The cost or repair for this is about 1/3 the value of the vehicle. It is unfortunately in need of replacement.
The second challenge was to the revenue of the organization as a whole. In March 2010, the Lwala Community Alliance received a large one-year grant from Ronald McDonald House Charities (RMHC) which supported most operations for the year. The grant stipulated that all funds had to be spent in 12 months. We applied again for 2011 funding, but RMHC was not able this year to award ongoing support to its international grantees. This significantly reduces revenue projections for 2011.
In August, September, and October 2010 we continued to experience low patient numbers following the implementation of the new patient fee in June. During this reporting period, the Lwala staff worked with the community to find a corrective. Through formulating a new flat fee for children under 5 and reaching out to the community with health education programming, the patient numbers have begun to rebound. By January 2011, outpatient numbers were up to 733 from 428 in November and 392 in December. In all departments in January, the health center saw 1,269 patients, compared to 961 in November and 771 in December.