Kenya: Making a difference in Lwala
December 4, 2012
James Nardella and Katherine Falk
Provide funding and support to the Lwala Community Hospital that serves the population of North Kamagambo in Migori County, Kenya. 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.
The health center was recently upgraded to a community hospital with RMF funding, and is part of a larger effort to achieve holistic health and development in Lwala, including educational and economic development.
Photo: Lwala Community Alliance staff share health messages at the event on World Contraceptive Day
Other programs include Emergency Ambulance Services and a Safe Motherhood (Umama Salama) Community Education Program. Based on the populations of school aged children and the number of families related to the 13 primary schools in the Lwala area, there are over 20,000 people who are able to access health care at the Lwala Community Hospital by foot or short motorcycle transport.
Project Objectives during this reporting period:
— 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
Results and/or accomplishments achieved during this reporting period:
Improve patient care and clinical operations
- Patient numbers continue to be high. At this continued rate, we will approach 25,000 visits in the year, up from 17,075 in 2011. Deliveries have been at record highs with 49 babies born at the Lwala Community Hospital in September.
- Due to fluctuations in deliveries, and in pediatric infections from diarrhea and measles, inpatient capacity has been over 100%.
- Staff education held weekly (topics: malnutrition, dry blood spot collection, pneumonia, neonatal sepsis, UTI in children, brain development stages in children).
- Cervical cancer screening and long-term family planning methods clinic conducted in July.
- Staff trained weekly on ultrasound from radiology tech in July.
- Order placed for privacy curtains to be hung between inpatient beds to improve patient experience.
- Clinical staff are meeting to develop better protocols and systems to maintain regulations, particularly for night and weekend shifts in maternity.
- Family planning return cards with key vitals (B/P, weight, temperature, return dates) implemented.
- One Clinical Officer attended CME for 2 days on the new ARV treatment.
Improve access and facility infrastructure
- “Riders for Health” ambulance arrived in Lwala in August and is operating full-time, making many referrals.
- Road repairs by local crew continued to keep road passable.
- Heena Construction improved the toilets near the new wing, including connecting piped water.
- Kenya Program Director (KPD) met district engineers to request a temporary ladder to the footbridge; verbal approval given. Engineers plan to visit site in October.
- Alternative hand washing station put in place at the pharmacy.
- Former Education Coordinator’s house allocated to two nurses; another house is being subdivided to provide additional housing for one nurse.
Expand and improve quality of education programs
- Dismissal of Education Coordinator created the need to identify a new candidate. Distribution of job description and publication in process. Plan has been established to cover education department duties until a new coordinator is hired.
- 485 boys & girls sat for LCA sponsored practice exam from the 23-25th of July 2012.
- Attendance registers in 8 schools completed; now have accurate data for number of girls enrolled in school.
- Measurements of class 5 girls for uniform distribution completed in 7 schools; measurement of phase 3 school girls began in September.
- Pilot mentorship sessions by New Visions women conducted during measurements in five schools for girls in class 5-8.
- 5000 Liter water tanks delivered and installed at Kuna and Tuk-jowi Primary schools. Construction of latrines at Minyenya Primary is near completion.
- 1st Youth Peer Provider (YPP) session conducted with 13 primary school teachers who were trained as health club leaders.
- Youth Peer Provider (YPP) health clubs launched in September in all 13 primary schools. 250 students reached with sexual and reproductive health information.
- Progress reports for sponsored secondary students have been updated.
- Scholarship applications collected from all 13 schools. 26 forms were completed and returned to Kenya Education Fund, who will be providing 10 scholarships in addition to a possible 4 provided by LCA.
- LCA leaders attended annual education day for the whole zone in July.
Professionalize the organization through better policies and practices
- A request to change financial calendar year submitted to the NGO council; awaiting authorization.
- Patient record booklets revised to enhance comprehensive history taking.
- Clinical staff participated in developing MOH annual work plans for LCA; Clinical Care Manager will attend district meeting to compile the district annual work plan.
- Heads of department (HOD) meetings are happening every week with significant involvement of HODs in decision-making.
- Finance policies revised by accountant and HoDs.
- All HoDs submitted departmental budgets to LVDC for approval.
- Discussions are happening between KPD, deputy KPD, and Clinical Care Manager of ways to improve work environment and experience for both staff and patients.
Properly procure and account for physical, financial, and human resources
- KPD Robert Kasambala signed new 3-year contract in July.
- New Economic Development Coordinator hired.
- 5% increase in monthly ‘salaries’ line item for full time salaried staff due to pension contributions, which began in July. This replaces gratuity scheme, which had equal cost.
- Annual performance evaluations completed for heads of departments.
- 2 LCA drivers and 2 motorcycle outreach workers sent for safety training with Riders for Health in Kisumu.
- In final stages of procuring a large scale autoclave.
- New bank account for accepting donations in country opened and published.
Increase impact of health outreach programs
- 637 households enrolled in the MCH program.
- An all-time high of 58 deliveries (88%) occurred in a health facility in September. Increased neonatal care for both home and facility deliveries happened within 24 hours.
- 6 neonatal deaths reported in Quarter 3. Increase in number of deliveries has resulted in more complicated cases. Women also have been coming to the hospital, often later in their pregnancies, after receiving insufficient care from another facility. Monthly meeting held with CHWs to talk about improvements related to the neonatal deaths.
- 9 women in program referred for comprehensive obstetrics emergency care in Quarter 3.
- During clinical outreach in Kadianga in July and August, 67 children immunized, 8 ANC women given care, 7 women provided with FP, 30 men and women counseled and tested for HIV.
- 77 out of 84 women seen during cervical cancer exercise at Lwala Hospital in July were of reproductive age, 2 suspected cases reported, 42 of the total 84 were treated for STIs. Over 100 women came for Cervical Cancer screening day hosted at LCA in September (see Story 2).
- 115 families from community registered for NHIF (National Health Insurance Fund) in Quarter 3. 95% of the community health outreach team is now registered for NHIF.
- A total of 106 individuals reached through community and clinical outreach program.
- Health education program held for patients twice a week as they wait at the facility; messaging reached a total of 782 people in Quarter 3.
- Monthly WASH trainings continued, bringing the total number of WASH trained individuals to 742 since 2010.
- 2nd Annual WASH sports tournament took place in August. Over 5,000 community members attended (see Story 1). 98 counseled and tested for HIV during the tournament.
- Staff presented at Global Hand Washing Day celebration with 3,000 in attendance.
- Looming diarrhea outbreak case in Sumba area in August prompted a quick response from the outreach team. 19 cases reported for children under 5 years and 6 for above 5. CHWs visited 16 homes where the cases occurred and distributed waterguard, PUR and ORS.
Build capacity of community members in income generating activities
- DIG trainings on sustainable agriculture techniques continued; over 1,600 direct beneficiaries to date. Follow up with recent DIG graduates is taking place.
- DIG hosted a group of 40 HIV positive farmers where trainees demonstrated learned techniques in July. DIG also had visitors in August from other DIG projects in Kenya and Uganda to share lessons learned.
- As part of DIG's goal to expand community outreach program using regional leaders, 86 vegetable home gardens were established and 17 vegetable farmer groups were formed in the community.
- DIG (with help from a nutrition student from Vanderbilt University) conducted nutritional assessments and 6 nutritional trainings in the community.
- The New Visions Sewing group produced Thistle Farm bags, sanitary towels for local students as well as ones sold to WISER school, and new uniforms. The group also chose a new vendor for uniform materials for 2013.
- The chicken in the poultry project are now laying eggs.
- Many of the youth groups are becoming active in their home communities. Reported activities include fish farming, gardening, and tree planting.
Improve programs through better communication and monitoring and evaluation
- Weekly staff meetings held on Wednesdays.
- Meeting of department heads on Fridays.
- LVDC executive committee and staff leadership met to conduct midyear review of program plan progress.
Number served/number of direct project beneficiaries:
Outpatient Department Report
A total of 1,835 patients were seen during Q3. Reflects the number of patients reporting for outpatient care due to illness and does not capture the mothers and children who report to the MCH clinic for growth monitoring, immunizations, family planning, antenatal care and postpartum care.
Child Welfare Clinic
1,306 children under 5 reported for regular growth monitoring and immunizations.
Family Planning Clinic
264 patients seen
514 patients seen
1,583 patients reporting for HIV appointments
Deliveries and Postnatal Care
245 Women recieving postnatal care
Our 2nd Annual WASH Tournament was held over a 6-day period in August. A total of 6 men’s soccer teams, 2 women’s soccer teams, 5 women’s netball teams, 4 women’s volleyball teams, and 2 men’s volleyball participated in the tournament. In order to register to play in the tournament, all team members had to enroll in and complete a 4-day WASH (water, sanitation, and hygiene) training. Teams also paid a small registration fee to supplement the tournament budget. The tournament officials and planning committee members contributed food such as maize and beans to share at the event in order to help offset the budget. Several community groups set up stands to advertise and sell their products. In the WASH stand, WASH trainers conducted demonstrations on biosand filters, pit lining, solar disinfection, keeping safe water safe, hand washing stations, and rain water harvest. Many people stopped by the stand and asked questions related to the demonstrations.
One of the participating soccer teams in the 2012 WASH tournament
In between the sports matches, our staff gave talks on a variety of health topics. Raffle tickets were also sold for prizes such as liquid soap, nails for constructing drying racks and latrines, and WASH promotion t-shirts. These prizes were also awarded to children who were able to successfully answer WASH-related questions. About 5,000 people from the community were in attendance and, once again, the tournament was a great success.
Community members interact with our staff at the WASH stand
World Contraceptive Day
In September, we honored World Contraceptive Day by hosting an on-site event that was open to the community. The day included presentations, health education messages, and free cervical cancer screenings to all women in the district. Our staff also distributed long-term family planning methods and 32 people were counseled and tested for HIV. Two drama groups presented plays on helping men accept family planning in their homes and promoting hospital deliveries. The district public health nurse educated those in attendance on a variety of family planning methods. In addition, over 100 women were screened for cervical cancer. The event was a success, with about 250 community members attending. Visitors included 12 district Ministry of Health officials and the regional APHIA Plus private public partnerships coordinator.
Women wait to be screened for cervical cancer at the Lwala Community Hospital
Beneficiary Profile: Denis Omondi
Denis Omondi was born in 1982, the youngest of seven. His father died shortly after his birth. His mother, a peasant farmer, raised him by herself along with her other children. Through a scholarship he earned from the Lwala Community Alliance, Denis completed 4 years of high school where he played soccer and competed on the debate team. From there he was selected for a Lwala Community Alliance loan to attend Moi University in Eldoret, preparing to be a high school teacher. His high grade average qualified him to receive government funding to complete his college education. Our initial investment in Denis is showing great returns.
Throughout his university career, Denis has volunteered in various programs of the Lwala Community Alliance. Earlier this year, he organized a youth group in Lwala to start a poultry enterprise. This initiative has expanded to nearly 300 youths in area villages. Denis hopes that they will establish good financial practices, which will in turn create income-generating opportunities and improve their livelihoods. The investment we have made in Denis has not only supported his own growth and achievement, but is now having far-reaching impact. Denis’ personal story demonstrates how building the capacity of one individual can advance the life of a whole community.