Kenya

Background

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.

Photo: Staff work with youth in outreach activity focusing on reproductive health

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 Goal:

The Lwala Community Alliance is a non-profit health and development agency working in Nyanza Province, Kenya.  Through the Lwala Community Hospital, the organization provides more than 15,000 patient visits each year. The mission of the organization is to meet the health needs of all people living in north Kamagambo, including its poorest. The hospital is part of a larger effort to achieve holistic development in Lwala, including educational and economic development.

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

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

• Funded personnel costs for Clinician in Charge, Teresa Kemuma
• Funded maternal and child health costs including:
• Personnel costs for Nurse Rose Gayo and Nurse Aid Joash Solo
• 58% of medicine costs
• Funded ambulance repairs and maintenance
• Funded fuel for ambulance to provide emergency transportation
• Funded obstetric emergency referrals

Improve patient care and clinical operations

• Overall patient numbers continue to be over 2,000 per month and were over 2,200 in some months in 2012.
• Inpatient admissions continue at about 60 per month.
• Continued Medical Education (CME) for staff held twice per week, except in late December. Health eVillages iPads and iPods helpful in diagnosis, management, and for educational content for beneficiaries.
• Twice weekly patient education session conducted, i.e. malaria prevention, malnutrition.
• Progress made on privacy concerns with patients (curtains between beds hung and improved protocol in interrupting clinical visits) but continued emphasis needed in 2013.
• Patient record booklet revised to larger size. Still maintaining separate records for outpatient, inpatient, HIV, and maternal and child health services.
• Monthly clinical outreach to catchment villages continued, offering services such as immunization, HIV testing, family planning.
• One nurse attended week-long training on integrated management of adult illness (IMAI).
• One nurse attended a nutrition stakeholders meeting in Rongo that was focused on improvement of nutritional status of early child development (ECD).
• One nurse participated in the measles campaign with the Ministry of Health.
• 3 staff members attended the Child Survival and Development (CSD) sub-committee task force meeting at Rongo District Hospital held in October.
• Stock-outs of some family planning commodities/childhood immunizations occurred at times.
• A one-day male circumcision clinic held in December.

 Improve access and facility infrastructure

• LCA management staff toured the facility/hospital determining areas that needed improvement/ maintenance. Maintenance calendar being enacted.
• New ambulance is operating full time, making many referrals.
• Motorcycles from Riders for Health running behind in procurement schedule. Expected by late January 2013.
• Road repairs by local crew continued throughout Q4, keeping road drivable in rains.
• 3 contractors bid on attaching semi-permanent stairs to footbridge in November 2012, contractor selected and work began in December 2012.
• No new staff housing was added in 2012; this issue will carry into 2013.

Expand and improve quality of education programs

• Dismissal of Education Coordinator in Q3 created the need to identify a new candidate. Hiring process was not complete by end of Q4; targeted for January 2013.
• Kenyan Education Fund (KEF) completed preliminary selection of 12 students for secondary scholarships; final decision pending in Q1 2013 based on KCPE scores.
• Successful Youth Peer Provider (YPP) training session with primary school teachers took place.  23 teachers from 13 out of 15 schools participated.
• School-based life skills and health programs held at schools during teachers’ strike and during holidays when students were not in school. 
• Lwala staff participated in Zonal Education Day and was highlighted during the event by teachers and education officials as a major driving force for girls’ education and quality education in the area.

Professionalize the organization through better policies and practices

• New work shift arrangement to cover night and weekend calls introduced.
• Departmental reports and 2012 strategic plan updates completed and submitted by the HODs in November.
• Meeting of Heads of Departments (team leads) held twice per month.
• Kenya Program Director and Deputy Program Director to review personnel handbook for revision in Q1 2013.

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

• Continued receipting of all expenses, monthly mailing of receipts to US before or on/10^th of every month, and monthly reconciliation of all expenses.
• Working to move Kenya monthly budget cycle forward one week to get earlier input from team leads.
• Working with KEMSA and MoH to procure more drug supplementation.
• Ultrasound was still down during Q4 due to burned circuit board.
• Team Leaders effectively distributed responsibilities while staff took their holiday leaves.
• 1 LCA driver attended training with Riders for Health in Kisumu in November.
• Procured a large scale autoclave.
• Loaned hemogram machine to lab was useful during Q4. Purchase recommended.

Increase impact of health outreach programs

• Ÿ809 households enrolled in the MCH program.
• This department continues to employ more than 45 local people.
• Due to maternal health outreach, skilled deliveries increased to 89% compared to a county average of 35%. In December, the percentage of deliveries reached 97%.
• 404 births recorded in catchment area since program start in May 2012; 347 of those babies delivered at a health facility; 383 received essential newborn care within 24 hours and 404 received care within 7 days of birth. Percentage of women attending 4 antenatal care visits during pregnancy rose in Q3 to above 90% but stagnated somewhat in Q4, back down to 71%.
• Monthly Cervical Cancer screening days hosted at LCA with MoH during Q4.
• A total of 6,582 pupils from 18 schools in North Kamagambo given deworming tablets.
• WASH trainings continue; a total of 807 people have been trained in WASH since the program began.
• Community trainings held on the making of biosand water filters for schools and households and the making of hydroform bricks for latrine construction.
• WASH Coordinator attended a two-day, province wide stakeholders meeting for the USAID funded WASH Plus program.
• WASH follow-up conducted in October with 600 households. Data collected revealed that 75% of community members are treating their drinking water, up from 64% in February.
• Latrine construction at Minyenya Primary School complete and in good use. Parents at Anding’o Primary School collected materials for construction of the base for water tanks.
• “Fun Fair” held at Lwala Primary School in December and targeted youth between the ages of 10-16. Staff shared messages on sexuality and reproductive health as well as WASH.
• Clinical staff conducted a monthly clinical outreach in catchment villages.
• In December, 48 youth counseled and tested for HIV through the Youth Peer Provider (YPP) program, 5 individuals circumcised through a VMMC (voluntary male medical circumcision) outreach, and 8 individuals received long-term family planning methods during a family planning and cervical cancer screening exercise.
• World AIDS Day event held at Lwala Primary School in December. See Story 2 for details.

Build capacity of community members in income generating activities

• New sewing machines for New Visions purchased and delivered. The group completed orders of 450 bags for Blood: Water Mission, 480 Thistle Farm Evening Bags, and school uniforms/sanitary pads for 2013 distribution. New Visions selling garments locally at about $83 in monthly sales.Furaha Soap Making group is bringing in monthly sales of $24, well below target of $140. Economic Development Coordinator is working with group to increase outputs.
• New Visions and Furaha soap makers now have nicely made labels and logos.
• Economic Development Coordinator conducting outreach to potential economic partners such as Aqua Clara International, RANEN, GRACE-USA(Kenya Office) and YACREN-Rongo office
• Business skills training conducted in November for 22 DIG trained graduate members on “Marketing”
• “Budgeting and Customer Care Training” held in November for Economic Development Program activities with 35 total participants.
• By Q4, the Youth Poultry project was producing eggs and sales of approx. $300 per month, but due to poor organization among the group members, the Youth have not begun loan repayment for the $4,000. Economic Development Coordinator working with Lwala Village Development Committee and Kenya Program Director to rectify the issues with the group.
• DIG Farmer Field Training at Lwala Community Hospital property continued.
• DIG satellite garden at Kuna Primary is producing well. Satellite garden at Kameji Primary is still operational but less productive.
• Photocopier generating outside market sales of about $12/month. Lamination Machine acquired in November and generated $18 as income. 

Improve programs through better communication and monitoring and evaluation

• ŸWeekly staff meetings held on Wednesdays.
• Meeting of department heads on Fridays.

Number served/number of direct project beneficiaries:

A total of 2,085 patients were seen during Q4. 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

1,392 children under 5 reported for regular growth monitoring and immunizations.

Family Planning Clinic

299 patients seen

Antenatal Clinic

590 patients seen

HIV/AIDS

1,637 patients reporting for HIV appointments

Deliveries and Postnatal Care

217 Women recieving postnatal care

Success story(s) highlighting project impact: 

Youth Peer Provider program

In the fall of 2012, the Lwala Community Alliance implemented a Youth Peer Provider (YPP) program to provide sexual and reproductive health information and services to youth (ages 10-24) in North Kamagambo. The program was necessitated by the high rates of teen pregnancies and the absence of a program that directly tackles youth issues in this community. Studies have shown that peers are often the most influential people in adolescents’ lives because they share so many things in common. The YPP program envisions training youth who will act as the providers to their peers. The YPPs will provide information and refer their peers for services in health facilities within the location. Evidence in other locations show that a Youth Peer Provider model can improve acceptability and convenience of contraceptives. Trusted, familiar peers can be trained to provide family planning education and act as linkage workers to commodities and help overcome the knowledge and opposition barriers to use of contraceptives.

The activities of the YPP program are as follows: 1) host 15 health clubs in primary schools to train and prepare the pupils for the YPP role, 2) conduct biweekly youth-only clinics to provide services to the youth, 3) conduct youth specific health outreaches once a month to target both out of school and in school youth, 4) coordinate youth-focused holiday activities in the form of games, sports, debates, and health talks through peer-led approaches, and 5) include local secondary schools in order to implement these various activities.

The Lwala Community Alliance has been providing family planning services since 2008 and has significant capacity to reach youth with these services. This is of obvious value because not only can family planning reduce unwanted pregnancies, but it is a cornerstone to any HIV prevention and PMTCT program.

World AIDS Day celebrated in Lwala

This year on World AIDS Day in December, we hosted a community outreach event at Lwala Primary School. The theme of the event was “Getting to zero related HIV deaths, infection, stigma, and discrimination.” The day-long event was planned and coordinated by the clinical team from the Lwala Community Hospital. While waiting for more adults to show up after setting up the venue, the clinical team was able to deworm 30 children who were present. Music was played through loudspeakers, which helped attract more people to the event. One of the lab techs delivered a health talk on HIV/AIDS prevention, treatment, care, and support to approximately 50 adults. Following the health talk, four positive living community members shared testimonies about their battles, victories, and perspectives on being the face of HIV/AIDS in a community that holds stigma around the virus.

Photo: Staff incorporate games into the outreach activity to engage the youth

In particular, Mercy a peer educator who is living positively with HIV, narrated how she has suffered stigma and discrimination from her immediate family. Through this episode, she became stronger and accepted her status, which has enabled her to effectively reach out to the community in North Kamagambo and communicate that HIV does not have to be a death sentence. Mercy has explored other interests in her free time, such as hairdressing and tailoring, which enables her to generate extra income. To further demonstrate her message, she even danced in front of the crowd to prove that individuals with HIV/AIDS can still enjoy good music and life! The Lwala Community Alliance representatives awarded the four individuals who shared their stories with T-shirts and sarongs. The staff then performed a skit on the spread of HIV and organized group games such as a sack race, an egg race, tag, and a balloon toss. Towards the end of the day, the clinical team distributed 600 male condoms to adults. All in all, the event was a success and actively engaged the community in positive messages related to HIV/AIDS.

Beneficiary profile: Martha Amondi

Martha Amondi lives in Lwala and was one of the first women to be enrolled in the maternal and child health outreach program in the spring of 2012. In visiting her home for the first time, the community health workers initially talked to Martha’s mother-in-law who had not yet been informed of the benefits of going to a hospital to deliver a baby with a skilled attendant. The lead CHW, Euniter, told her about the health benefits and communicated that the medical checkups would be free of charge. After this initial visit, Euniter began to visit Martha every Monday for 30 minutes each time. During these visits, Euniter educated Martha on how to have a healthy pregnancy and how to care for her newborn. At the time when Euniter started to visit, Martha was 6 months pregnant. Euniter taught Martha how to nurse, what kind of nutrition is beneficial, the danger signs to watch out for during her pregnancy, and passed along information about important vaccinations.

One night in March, Martha’s water broke while she was at home. As she started having back pains, Martha told her grandmother that the baby was coming. They called Euniter, who then called the hospital and had the ambulance come and pick Martha and her grandmother up and bring them to the hospital, which was 5 km away. Home is 5 km from the hospital. After 8 hours of labor, Martha gave birth to a beautiful 6-pound baby girl named Fiona. Martha and the baby spent one day and night in the hospital; during this time, the nurses showed Martha what to give the baby and how to nurse her. One week after delivery, Martha came back to the hospital with Fiona for her first vaccines. Euniter then followed up at her home 3 weeks later to make sure Martha had the support she needed and to remind her about the 1 month, 6 month, and 9 month check-ups. Martha has faithfully attended all of the checkups, getting the proper vaccinations and doses of Vitamin A for Fiona. Due to the positive experience Martha had with the Lwala Community Hospital and in the outreach program, she is now telling other pregnant women in the community about the benefits of enrolling in antenatal care and delivering with a skilled attendant. Martha thanks the staff of the Lwala Community Alliance, who she says has “enhanced our community with the medicine they are bringing around in the community.”