Kenya: Reaching out to Mothers and Children in Lwala

September 14, 2012

James Nardella and Katherine Falk

Photo: A mother participates in home-based outreach on maternal and child health through the RMF/Lwala Community Alliance  program (see success stories at the bottom of this page)

Project Goal:

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.

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:

Continue and 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

Summary of RMF/WCF-sponsored activities carried out during the reporting period under each project objective:

  • Paid salary and other employment costs for Clinician in Charge, Teresa Kemuma
  • Paid for maternal and child health costs including:
  • Salary and other employment costs for Nurse Ruth Ohour and Nurse Aid Joash Solo
  • 58% 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:

Continue and improve patient care and clinical operations

  • Ÿ Staff education sessions held weekly (topics: infection control, malnutrition, PITC).
  • Patient numbers in the 2nd quarter are even higher than 1st quarter, particularly antenatal care, immunizations, deliveries, and HIV appointments. Deliveries in May reached an all time high as a result of our health outreach to women (see tables for details).
  • In addition, delivery by a skilled attendant in the region as a whole has increased. For example, in May 2012, 36 deliveries took place at the Lwala Community Hospital, and in the same month 12 more deliveries took place at other nearby facilities as a result of the LCA outreach activities.
  • Ultrasound services began in June, with a tech from Kisii coming twice per week and training clinical staff. Baby incubator has also arrived.
  •  A team from Allscripts conducted continuing medical education on orthopedics.

Improve access and facility infrastructure

  • Riders for Health Memorandum of Agreement signed by ED and procurement of new ambulance restarted after earlier complications with Kenya Revenue Authority and customs. Shifted from Toyota of Japan to Toyota of Gibraltar, who specializes in ambulances for NGOs. It is in Nairobi now; estimated arrival in Lwala is now early August. Moderate engine repair was done on old ambulance in the meantime.
  • High rains in April and May brought road issues, but due to repairs throughout the year the hospital remained more accessible than in years past.
  • 2 or more referrals are happening daily so referral costs are rising significantly.
  • Patient access from across the river was still difficult due to poor bridges and one community death occurred at bridge crossing.
  • High number of clients due to success in community outreach programs is creating concern about understaffing within the hospital and long wait times for patients.
  • Due to housing constraint, staff houses meant for 1 staff/family instead are being partitioned to make way for 2 staff/families.
  • Education coordinator moved to Rongo, making some additional housing available. Also implemented a temporary solution by renting housing at Sare for two staff members. Long term solution needed.
  • Non-functioning latrines at upper gate of the property were transformed into shower rooms for staff and connected to water line.


Expand and improve quality of education programs

  • Stakeholder planning meetings held at Andingo Primary School (students, teachers, parents & School Management Committee) completed in the week of 21st – 24th May.
  • School based de-worming done in 14 primary schools (4,456 pupils)
  • Construction complete on 6 latrines, which are now open at Kadianga Primary School. Digging of the latrine pits began for Minyenya Primary School.
  • Plans and procurement procedures are ongoing for purchases of Kuna Primary water tanks.
  • New secondary school sponsorship selection guidelines distributed.
  • 2 Vanderbilt graduate interns worked on monitoring and evaluation of girls’ education program.
  • Visit to Intel project on Rusinga Island to understand future potentials with Intel in Lwala.
  • Hired Education Aid to reduce strain on Education Coordinator.
  • New measurements of class 5 girls for 2013 uniform distribution are in process in all 8 schools.
  • Initial plans have are underway for the establishment of school-based health clubs at Kuna Primary and Lwala Primary.

Professionalize the organization through better policies and practices

  • LVDC (Lwala Village Development Committee) has reviewed and approved all budget and actuals before submission to the US.
  • LVDC meeting took place and approved July 2012 budget and change of the fiscal year from January – December to July – June pending approval by the NGO council.
  • Sent 2011 audit to the NGO council.
  • Heads of department (HOD) meetings are happening every week with significant involvement of HODs in decision making.
  • Posting organization-wide calendars in each department.
  • Policies on vehicle usage and procurement are now in place.
  • Staff documents or certificates are being updated in line with regulations.

Properly procure and account for physical, financial, and human resources

  • Procured furniture, computers, and maternity equipment for MCH outreach program.
  • Hired an additional security guard.
  • Fluctuations in nursing staff continue due to more competitive salaries nearby. 2 new nurses joined the staff in June.
  • Ultrasound tech contracted and began in mid-June.
  • Photocopier was purchased and is being used by LCA departments.  Plans to open it to community use once someone is hired to manage it.
  • Research done into electronic pharmacy stocktaking system.

Increase impact of health outreach programs

  • ŸPublic Health team is very well led and organized. Data capture is excellent. Mercy Owour, the community health coordinator, officially earned her MPH in May.
  • 546 households with women of reproductive age currently enrolled in the MCH program.
  • Out of the women enrolled in the program, 77% of pregnant women are attending ANC visits at the hospital, 77% of children under 9 months are getting immunized, and 80% of pregnant women are delivering in the facility, up from a previous average of 40%.
  • 3 deaths reported in the MCH Program (2 perinatal still births and 1 infant death).
  • Introduced a program to incentivize MCHWs/Umama Salamas to get people enrolled for NHIF by offering 1 free month of NHIF for every 3 community members they enrolled.
  • 8 health education programs held in the hospital with patients and the clinical staff on breastfeeding, Typhoid education, nutrition and immunization, hand washing and hygiene, and biosand filter demonstration; 926 attendees.
  • Reduced diarrhea cases for children under 5 and adults by 50% compared to Q1.
  • 600 households and 15 primary visited in the WASH door to door follow-up. 4-day WASH trainings continue to take place with high attendance, and the second annual WASH sports tournament is scheduled for August. More than 600 community members are WASH trained to date.
  • Community members are requesting more supply of Water Guard and Pur to be provided during follow-ups but this is not sustainable.
  • Health message shared on tetanus with individuals who were attending a burial ceremony of individual who had died due to tetanus

Build capacity of community members in income generating activities

  • After 6 months with first 3 groups, Development in Gardening (DIG) started training a second set of groups. All DIG trained groups met to form regional groups and elect their leadership. About 45 members attended.
  • DIG satellite garden at Kuna Primary School is going well while Kameji garden needs more attention. New adult trainees have been identified both at Kuna and Kameji to also learn at the school gardens. One group also started a 1-hour adult education class in learning how to read and write.
  • Hospital garden is selling kale, green peas, butternut squash and cowpeas to the staff, to the hospital kitchen and to the guest house.
  • Lwala youth group has been undergoing weekly trainings on poultry production. Youth Group also received financial training from Equity bank and opened a bank account in order to receive their KSh 200,000 loan for poultry project. DIG poultry management trainings to the youth group completed. They now have 200 (8 weeks old) layers that are growing well.
  • New Visions sewing group produced uniforms for nurses and Umama Salama workers in the hospital. They also finished and distributed uniforms for late coming girl students. They are staying busy with measuring girls for 2013 uniforms, making pads for another NGO customer near Migori, and making bags for Thistle Farms. They continue to experiment with new projects including children’s clothes.
  • Biosand filter making started as new microenterprise (trained by Aqua Clara). Completed training and installation of biosand filter at hospital. Currently procuring materials to build and sell within the community.
  • Completed training for local carpenters in constructing latrines through use of hydroform bricks (advised by Ministry of Public Health).

Improve programs through better communication and monitoring and evaluation

  • Weekly staff meetings held on Wednesdays
  • Meeting of department heads on Fridays
  • Community Dialogue Day was positive, productive and greatly appreciated by the community.
  • Work is being done to encourage youth throughout North Kamagambo to create and register youth groups that could be sponsored by LCA but still autonomous and which would provide a population from which interns, volunteers and program participants could be found while giving youth a positive activity to engage in.
  • Monitoring and Evaluation skills building workshops for Heads of Department held by Vanderbilt graduate students.

Number served/number of direct project beneficiaries:


A total of 1,751 patients were seen during Q2. 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

1,185 children under 5 reported for regular growth monitoring and immunizations.

Family Planning Clinic

226 patients seen

Antenatal Clinic

390 patients seen


1,650 patients reporting for HIV appointments

Deliveries and Postnatal Care

162 Women recieving postnatal care

Success Stories:

MCH Outreach Update

This past April, the Lwala Community Alliance launched a community health outreach program to recruit and retain pregnant women in the entire MCH (maternal and child health) continuum of care. A team of 10 community health workers and 30 community health promoters have been trained and deployed to increase access to delivery by a skilled attendant, establish a rapid transport network for women in labor, offer 24 hour post-delivery hospital stays, and conduct home-based follow-up during the postnatal period. Since outreach began, a total of 546 households have enrolled in the MCH program. Out of these households, 77% of pregnant women are attending antenatal (ANC) visits at the clinic, 77% of children under 9 months are receiving immunizations, and 80% of pregnant women are delivering in the facility, up from a previous average of 40% per month. In addition, the number of women seeking family planning services as well as postnatal care within the first 24 hours after delivery continues to increase. (See Photo at top of the page)

“Groundbreaking Woman”: Emily Achieng

 Emily Achieng Obunga is a mother of two and at 24 years old, she is the second youngest participant in the Development in Gardening (DIG) agricultural program training. When Emily first started the training, she had just given birth to a son. Emily started bringing the newborn to the trainings, wrapping him around her back while she worked.

The baby at first had no name, as is tradition. In Luo culture, parents often wait days or even weeks before naming their baby. Emily, who was inspired by DIG, decided to name her baby, DIG. Baby DIG is now 9 months old, strong and healthy and is already learning how to walk!Emily does not only work hard in the garden, she also has an amazingly innate talent for organic agriculture. She has a huge garden at her home in Kameji Village. She has planted an amazing variety of cowpeas, kales, onions, cilantro, carrots, French beans, pumpkins, and spider plants.

“From the things we get here (at the DIG training) we go and plant them in our garden. We save lives, improve our nutrition, then we also have some little money from the garden.I think I am employed in my garden. It is like my self-employment!”

Emily’s self-employment is earning her 700 KSh a week for a total of 8,400 KSh in the past 3 months. She has trained over 10 of her friends in the area and is looking to further her agricultural education by applying for scholarships to go to college for a degree in organic agriculture.


Mary is 34 years old and comes from a nearby village called Sumba. She has 3 young children and some years ago, her husband was injured in an auto accident and was forced to retire from work. Due to her husband's disability, Mary had to take on the major responsibility for financially supporting their 3 children, feeding them, clothing them, and, most importantly, keeping them in school. There was one major challenge for Mary though – she was not well herself and was unable to farm. Like one in 5 of her community neighbors, Mary had contracted HIV unknowingly. She discovered her status in 2008 when she was ill and came for tests at the Lwala Community Hospital. When she heard the news, she cried…but then the staff at the hospital comforted her and encouraged her to accept her status and to find a way to live with it. So Mary began to take life saving anti-retroviral drugs and within months, she began to get stronger and healthier. Working with the Lwala staff and some other openly positive community members, she helped form the first HIV support group in the area. Mary says that meeting together as people living with HIV made everyone less fearful. They were determined to help each other stay on their drug regimen and to spread the word so others would be tested.

With the social support and healthcare she needs, Mary has become an active participant in the development of the community. In 2010, she was trained in Water, Sanitation and Hygiene and then deployed in her home area to teach her neighbors what she learned. In 2011, she joined other support group members for 6 months of agricultural training at the hospital. Together they learned new techniques to increase crop yields and their own nutritional intake. At first, Mary says, her neighbors laughed at her for going to these trainings. But now that she is growing kale, onions, tomatoes, cucumbers, carrots, and even pumpkin in her home garden, these same neighbors have become customers. Mary's leadership and entrepreneurial spirit impressed the members of the New Visions sewing cooperative in Lwala, and so when they were adding two new members this year, she was selected right away. 

Mary embodies the Lwala Community Alliance’s multi-dimensional model of development. For her, these ideas are personal. When she was diagnosed with HIV, healthcare was not the only answer she needed. She represents the real changes that come when a person who once was sick is now healthy, is feeding herself and her family, and is reaching out to others in her community. This is the holistic transformation we strive for.

Country Page: Kenya Initiative Page: Lwala Healthcare Project