Closing the Gap in Lwala

September 5, 2013

Katherine Falk

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.

Lwala school girls participate in a mentoring session (see Success Story below)

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: 

  1. — Improve patient care and clinical operations
  2. — Improve access and facility infrastructure
  3. — Expand and improve quality of education programs
  4. — Professionalize the organization through better policies and practices
  5. — Properly procure and account for physical, financial, and human resources
  6. — Increase impact of health outreach programs
  7. — Build capacity of community members in income generating activities
  8. — Improve programs through better communication and monitoring and evaluation
  9. Summary of RMF/WCF-sponsored activities carried out during the reporting period under each project objective (note any changes from original plans): 
  • Funded maternal and child health costs including:
  • Personnel costs for Nurses Rose Gayo and Diane Aguta and Nurse Aid Rosemary Akello
  • 58% of medicine costs
  • Funded ambulance repairs and maintenance
  • Funded fuel for ambulance to provide emergency transportation
  • Funded obstetric emergency referrals

Results and/or accomplishments achieved during this reporting period:

Improve patient care and clinical operations

  • Average overall patient numbers totaled over 2,800 in April, May and June.
  • Total of 49 deliveries at the Lwala Community Hospital in April, 62 deliveries in May, and 55 deliveries in June.
  • As a result of conducting home-based HIV counseling and testing, 49 couples were tested in ANC in the month of June. In previous months, we have reported zero.
  • Transition of Ministry of Health (MOH) from national to county level authority has been disruptive for supply chains, decision-making, and supervision.
  • In June, a family planning clinic was conducted in collaboration with the WASH mobilization. 29 patients were counseled on FP methods, 3 jadelles inserted, 12 condoms supplied, 4 pregnancy tests done, 17 STI screenings conducted, 31 HTC done, and 6 people were treated with minor illnesses.
  • In order to improve the patient experience and flow, a one week internal review of 285 patient wait times was conducted to better understand the patient flow and the amount of time patients spend with a provider vs the amount of time patients wait to be seen. Results indicated that on average, patients spent 75% of their time at the facility waiting. The average time in facility is 2 hours, 6 minutes and the average wait time is 1 hour, 31 minutes. Staff is working on these issues to minimize wait time and maximize time spent with a health care provider.
  • Clinical staff attended various trainings on FP counseling, long-term FP methods, post-abortion care, neonatal resuscitation, pediatric ART, TOTs on youth-friendly clinic, AFP microscopy and quality assurance.  In addition, each clinical staff member is now in charge of a particular department to enhance quality care and easy reporting.

Improve access and facility infrastructure

  • New kitchen and large pavilion seating area was completed.
  • Ongoing repairs and maintenance continue for buildings and additional staff housing.
  • To make space and save money, the economic development office was moved off-site by 100 yards. New space had to be refurbished and given electricity.
  • Minor road work between the hospital and the Minyenya junction is ongoing.
  • In May, a Migori County delegation of government officials visited the Lwala Community Hospital and promised to work closely with the facility in the area of infrastructure development.
  • The health outreach vehicle was out of service for 3-4 months due to major repairs ($8,000).
  • Riders for Health fitted the ambulance with 4 new tires. 

Expand and improve quality of education programs

  • 2 education interns joined the staff in April.
  • Launched Salama Pamoja, a program to reduce gender-based violence. 9 mentors for girls’ mentoring program were trained in May. Weekly sessions in schools and monthly sessions outside of school are being conducted. See Story 2 for details.
  • 36 in-school girls were recruited for mentoring sessions. Topics covered in sessions included identification of issues affecting girls, community mapping, identification of safe spaces, and adolescent development.
  • As part of the Youth Peer Provider program, Youth Friendly Services continue to be held on Sundays at the Lwala Community Hospital targeting students aged 10-24.
  • Youth Peer Provider Program patrons received pamphlets that include guidance for conducting sex education at the schools.
  • WASH education activities for students were held in June at Lwala Primary School.
  • School health clubs patrons’ meeting held during which reports were shared on the progress of clubs in schools.
  • 6 Phase III schools have turned in work plans for water-tank installation. Komito and Sumba have already completed the water tank bases and will be the first to receive the tanks.
  • 3 schools have turned in work plans for latrines (Anding’o, Kuna, Tuk Jowi).
  • All 29 sponsored students are continuing with their education (currently interrupted by teachers’ strike) except for one due to illness.
  • Vanderbilt University summer intern has been helping the education department with technology training, monitoring tools for health club activities, and girls’ mentoring sessions.

Professionalize the organization through better policies and practices

  • Lwala Community Alliance underwent external institutional assessments to evaluate the Kenya organization’s readiness in terms of finance, governance, personnel, and policies. Major findings still to come.
  • Through an invitation from NOPE, the Kenya Program Director attended a national forum of other civil society organizations hosted by USAID in Nairobi.

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

  • During Q2, one new nurse and one new social worker have been hired.
  • QuickBooks 2013 was procured; data update is ongoing.
  • Audit of Kenyan accounts for 2012 is under review.

Increase impact of health outreach programs

  • 1,352 clients are now enrolled in the maternal and child health program.
  • The percentage of births through skilled attendants increased to an average of 96%.
  • Launched the new long-term family method planned program, Closing the Gap (CTG), to provide information and services related to family planning and sexual and reproductive health (see Story 1 for details).
  • Number of women reached by long-term FP increased by 60% for implants and 6% for IUCDs.
  • Youth Peer Provider (YPP) training for health club members held in April with 47 pupils attending. YPP school holidays activity took place at Lwala Primary School in April with 60 youths between 10 to 24 years attending and many more under age came to observe.
  • Trained 21 out of school YPPs in June to assist with demand creation for long-term family planning methods and distribution of condoms.
  • WASH training for students held in April with 25 pupils in attendance.

Build capacity of community members in income generating activities

  • 36 community members trained on sustainable agriculture in Tuk Jowi and Sumba in a community training conducted by DIG.
  • DIG staff members went to KEFRI-MASENO for capacity building training surrounding organic farming techniques.
  • Permaculture farming initiated at Tuk Jowi and Kuna Primary Schools in April.
  • Youth Groups who are near a water source were encouraged to consider starting aquaculture projects.
  • New Visions Sewing Group tailors agreed to contribute 10% of their income to their health fund. Total income in June was around $1,650.
  • 2 Furaha Soap Making members attended the Kuja School stakeholders’ meeting and sold around $33 worth of liquid soap.
  • Income was generated through biosand filters and the lamination, photocopying, and binding machines.
  • Poultry project is not going as well as planned. No income realized for June as the chickens stopped laying eggs due to stress from lack of management. Hired new caretaker. Members agreed to do away with the project systematically.

Improve programs through better communication and monitoring and evaluation

  • LVDC meeting held each month during Q2 and the budgets were approved with some amendments.
  • Developed community tracking and monitoring tools for the Closing the Gap program.

Number served/number of direct project:

Outpatient Department Report

A total of 2,963 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.


73 patiens treated

Child Welfare Clinic

563 children under 5 reported for regular growth monitoring and immunizations.

Family Planning Clinic

102 patients seen

Antenatal Clinic

210 patients seen


640 patients reporting for HIV appointments

Deliveries and Postnatal Care

114 Women recieving postnatal care

Success Stories

Closing the Gap

In June, the Lwala Community Alliance launched the “Closing the Gap” program in conjunction with the Ministry of Health (MOH) and other partners. This program provides quality reproductive health information and services for women and young people. The program works to increase the capacity of the Lwala Community Hospital and the nearby Minyenya Health Center and supports Community Health Workers (CHWs) and Youth Peer Providers (YPPs) to deliver quality services and information surrounding family planning, youth friendly sexual and reproductive health, and post abortion care (PAC). The primary goal is to train healthcare providers on post abortion care, contraception, and the use of long-term reversible methods (intrauterine devices and implants), to provide women with long-term methods, and to educate 60 CHWs and 45 YPPs so they might generate community demand for family planning. The target is 1,600 people provided with short-term contraception methods and 1,800 provided with long-term methods in 2 years.

During the program launch in June, the MOH assisted the hospital with ToT trainings and provided Family Planning and PAC guidelines. Through the CTG program, the CHWs and several of the YPPs have already been able to generate demand for long-term family planning methods. Within one month, the percentage of implants increased from 10% to 60%; IUCDs increased from under 2% to 9%.Since the program is growing, fast track training for service providers is needed, as the numbers are likely to increase in the subsequent months. In addition, more staff is needed to equal the demand created for the various services.

A community member receives his certification for completing training on grassroots advocacy and demand creation for long-term family planning methods.

Gender-Based Violence Program launch (photo at top of page)

According to the recent Violence Against Children in Kenya survey, 3 out of 10 females aged 18-24 experience sexual violence prior to age 18. Many perpetrators of violence are known to the girls and are often at least 10 years older. This issue was propelled into the local spotlight due to several reported incidences of gender-based violence in the Lwala area. In response to violence against girls, Lwala Community Alliance launched Salama Pamoja to empower girls to be agents of their own safety and success. The phrase “Salama Pamoja” means “Safe Together,” building on the idea that girls can come together to identify their own best tools for safety. With our new partners Together for Girls and Population Council, we are launching mentoring programs in eight local schools, reaching 130 girls. For out-of-school girls, we are organizing monthly Girls’ Clubs for 100 girls to connect them to supportive programs, income-generating activities, and encourage school re-entry. Salama Pamoja also provides training in mentoring and gender-based violence reduction for local teachers, program staff, education interns, and New Vision sewing cooperative members.

In order to sensitize community leaders and members to the various issues surrounding gender-based violence, stakeholders’ sensitization meetings were conducted in April. Attendees included a Ministry of Education representative from Rongo District, local religious leaders, head teachers of primary schools, female teachers from the schools, parents, Lwala Community Hospital health workers, and local government administrators.

A total of 36 at-risk girls in schools (12 pupils from three schools) have been recruited for school-based programs and have participated in 12 meetings to date. The mentors meet the girls once a week after school hours for a 2-hour session. A needs assessment has helped staff amend the curriculum to cater to the specific needs of the girls. The following topics were selected to guide the mentoring sessions: early pregnancies, early marriage, school dropout, drug abuse, unconcerned parents, and lack of basic needs.

A total of 28 out-of-school girls have been recruited across the communities for the Girls’ Clubs. These girls have attended a total of 11 sessions in locations identified as ‘safe spaces’ within their local communities. In addition, a3-day workshop for out-of-school girls was held in June. A total of 30 girls attended, 90% of whom were teen mothers. The workshop covered an in-depth explanation of the objectives of Salama Pamoja, child and human rights in accordance with the Kenyan Constitution, discussions and role plays on safe spaces, healthy living and hygiene, avoiding alcohol, tobacco and hard drugs, myths surrounding sex, early marriage and teen pregnancy, girl-child education, widow inheritance and wife battering/beating in North Kamagambo, inner strength, reproductive health and sexuality, STIs and HIV/AIDS, contraception, and the importance of family planning.

In Her Own Words: Lillian Anyango

“My name is Lillian Anyango, and I live near Lwala, Kenya. About one year ago, I gave birth to two healthy babies. The boy Geoffrey was named after his ancestor, and the girl is called Valery. Taking care of twins is not easy; they behave like they have one brain. When one is awake, the other is also awake. When one is crying, the other is also crying. The boy is more aggressive and stronger than the girl, but both are jealous and compete for my attention. I am proud to be their mother.

In my community, many women give birth in their huts without anyone with skills to help. Early last year, some people working with the Lwala Community Alliance started visiting all the pregnant women they could find. They are called the Community Health Workers.  One of these workers named Sheila came to me when I was 6 months pregnant. Because I was carrying twins, my pregnancy was a difficult one, and I could not sleep well because of stomach discomfort and back pains. Sheila would come visit me 3 times a week to see how I was fairing on. Over time when the problems increased, she would check on me twice a day.

Sheila encouraged me to go to the Lwala Community Hospital for check-ups. One day when the labor pains started, I immediately went to the hospital because Sheila had taught me that the complications I had been having could get worse if I attempted to deliver at home.  Sheila and the community health nurse came to check on me when they heard that I had come to deliver my babies. I had difficulty during my labor, and my blood pressure became very high. Sheila and the nurse called it eclampsia and rushed with me in the ambulance because I needed to go for a caesarian. I then was able to safely deliver my twins. I feel great to have these two babies because it is not easy to give birth to twins. Since they were born, I haven’t seen them get seriously ill except for the normal diarrhea that kids get when they are getting to a different development stage like crawling, sitting, and standing. I still take them in for checkups and shots at the Lwala Community Hospital.

The Community Health Workers have been very friendly, loving and caring to me and are committed to their work. Even after I had given birth, they kept on visiting to check on me and my babies. Sheila also calls me on my phone most of the time to find out how I am doing. If the Community Health Workers hadn’t given me good information about how to deliver safely, I am not sure that the outcome would have been the same. The Lwala Community Alliance has made a difference in my life and are doing good work with so many pregnant women and sick people in the community.”

Lillian (right) and Sheila (middle) with the twins

Country Page: Kenya Initiative Page: Lwala Healthcare Project