Progress Report

Lwala Community Hospital, Lwala, Kenya

Date: October 27, 2015 Prepared by: Liz Chamberlain I. Demographic Information 1. City & Province: Lwala Village, Kameji Sub-location, North Kamagambo Location, Rongo District, Migori County, Kenya 2. Organization: Lwala Community Alliance 3. Project Title: Lwala Community Hospital 4. Reporting Period: 7/1/2015 – 9/30/2015 5. Project Location (region & city/town/village): Lwala Village, Kameji Sub-location, North Kamagambo Location, Rongo District, Migori County, Kenya 6. Target Population: North Kamagambo Location and those surrounding– approximately 30,000 people II. Project Information 7. Project Goal:

Lwala Community Alliance (LCA) is a non-profit health and development agency working in Migori County in western Kenya. Through the Lwala Community Hospital, the organization provides 30,000 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. 8. 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 • Include community in program planning, 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: o Personnel costs for nurses Rose Gayo and Vincent Onsongo o 58% of medicine costs

10. Results and/or accomplishments achieved during this reporting period:

Hospital Program IMPACT: Sustained reduction of morbidity and mortality through complete and comprehensive access to quality healthcare for the people of North Kamagambo • The hospital connecting wing was completed and clinical services have fully moved into the new spaces,

including the lab, pharmacy, maternal and child health services and the registration office. • Monthly clinical meetings are becoming more regular as a platform for peer learning and feedback. • Support supervision from Ministry of Health is going on consistently.

• Orders for medicines and lab reagents have been placed on time and consistently. • Case reviews for all major occurrences at the facility are being carried out by the Head Clinician.

Public Health Program IMPACT: Improved and sustained positive health-seeking behavior of the people of North Kamagambo • Data reviews and mentorship for 80 community health workers is ongoing on a monthly basis and their strong

dedication to improving maternal and child outcomes is reported by the public health staff. • Latrine coverage in two villages reached 100% and the team is waiting for those areas to be officially declared

open defecation free. Two other villages are expected to follow in full latrine coverage in the next couple of months.

Education Program IMPACT: Improved graduation rates, educational results and health outcomes for school-aged girls and boys of North Kamagambo • Six sponsored students from LCA’s first graduating class have qualified to join university. • The out-of-school girls mentoring program is proving successful, as the participants are dedicated, participatory

and are showing improvement in their maturity and ability to handle responsibility. • A new e-Reader project is progressing well: pilot schools were identified in a competitive process involving head

teachers from all 13 public primary schools, a program assistant staff has been recruited, and the shipment of e-books is already in Kenya. The program will launch in January.

Economic Development Program IMPACT: Increased economic opportunities to promote self-reliance and sustained livelihoods for the people of North Kamagambo • Table banking groups are meeting regularly, supported by LCA staff, and members are progressing well in terms

of increasing savings and group unity. • The Economic Development Program is being evaluated and a new program structure will be implemented in

2016. The new design includes a focus on farming for business, non-farming employment, savings and access to credit, and building a stronger social safety net for community members.

• Focus group discussions were held with adolescent girls on the re-usable menstrual pads and design changes have been proposed for increased adoption.

Monitoring and Evaluation The M&E Team is responsible for all data collection and data management for the organization and is a support system for the program teams to successfully track and improve their activities. • Program teams are entering data consistently into our central data management systems; the data is then

checked for quality and analyzed for program feedback. • Development of organization-wide Key Performance Indicators is underway and will provide a useful platform for

sharing more results back to the program teams, management, and external audiences.

Operations The Operations Team is responsible for management of LCA’s buildings, grounds, assets, and technology and for oversight of policies impacting these areas. • The connecting wing construction is completed and clinical services are fully occupying the space; renovations of

the existing hospital are ongoing and expected to be complete by the end of 2015. • Road improvements near the hospital are ongoing. Finance The Finance Team is responsible for all Kenyan financial activities, including budgeting, billing, payroll, tracking expenditures and financial reporting. • An online salaries payment system was put into effect, improving the timely payment of staff salaries. • Monthly requisitions and liquidation of expenses are taking place in a timely manner due to new accounting

policies enacted by the finance team. Administration and Management • Julius Mbeya, a Kenyan national, began his tenure in July as LCA’s Managing Director in order to shift more

executive decision-making to Kenya. He has demonstrated strong leadership and is currently focusing on implementing LCA’s new 2020 Strategy and making decisions regarding the future of programming, personnel, and finances in Kenya.

• Executive Director James Nardella ended his 6-year tenure at LCA at the end of August 2015. The departure was

entirely amicable and was based on James’ changing family needs. An executive search firm was enlisted to recruit candidates in the early summer, and by the end of Q3, final candidates were going through a second round of interviews.

• Human resource consultants were hired in September to engage in a human resources review at LCA-Kenya, including a salary survey and exploration of retention strategies and a performance management system.

11. Impact this project has on the community (who is benefiting and how):

The primary beneficiaries of Lwala Community Alliance work are children, women, HIV infected persons, and the elderly. Prior to the establishment of the hospital, there was no immediate access to primary health care or HIV/AIDS testing and care. For this reason, the Lwala health intervention has focused on primary care for children, access to medicines (particularly vaccines and anti-malarials), HIV testing and care, public health outreach, and safe maternity. The impact has been substantial since opening, though more work is to be done and systems of measurement need to be strengthened. 12. Number served/number of direct project beneficiaries (for example, average number treated per day or per month and if possible, per health condition).

Outpatient Monthly Totals This chart 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.

Month Under 5 Over 5

Total Male Female Male Female July 202 170 261 393 1,026 August 146 105 227 322 800 September 117 101 174 303 695

Total outpatients for reporting period: 2,521 Average per month 840

Child Welfare Clinic Monthly Totals

This chart reflects the number of well children under 5 reporting for regular growth monitoring and immunizations.

Month New Clients Re-visits

Total Male Female Male Female July 22 20 204 227 473 August 21 19 204 211 455 September 22 30 185 190 427

Total: 1,355 Average per month: 452

Family Planning Clinic

Month New

Clients Re-visits Total July 92 51 143 August 40 94 134 September 64 64 128 Total: 405 Average per month: 135

Inpatient Ward Month Under 5 Over 5 Total

Male Female Male Female

July 22 14 25 38 99 August 16 9 20 23 68 September 10 7 6 18 41

Total: 208 Average patients per month: 69

Antenatal Clinic

Month New

Clients Re-visits Total July 41 88 129 August 38 91 129 September 26 87 113 Total: 371 Average per month: 124

Deliveries and Postnatal Care

Month

Number of deliveries at LCH

Deliveries at partner facilities through

MCH outreach Total

Women receiving postnatal

care Boys Girls July 19 19 9 47 48 August 19 22 11 52 53 September 25 18 8 51 51

Total: 152 Average patients per month: 51

HIV/AIDS patients reporting for HIV appointments

Month Under 5 Over 5

Total Male Female Male Female July 19 25 205 522 771 August 18 14 184 375 591 September 11 19 185 525 740

Total: 2,102 Average patients per month: 701

13. Number of indirect project beneficiaries (geographic coverage):

Approximately 30,000. The total population of North Kamagambo is 16,500, and programs are a magnet to people beyond North Kamagambo. 14. If applicable, please list the medical services provided:

• Basic primary care services • Maternal and Child Health Services

o Antenatal and Postnatal Care o Vaccination

o Growth Monitoring o PMTCT of HIV o Family Planning

• Treatment of TB • Comprehensive care for HIV including:

o Preventative services (including PMTCT and male circumcision), o Counseling and testing (voluntary, diagnostic, and provider-initiated), and o Care and treatment for people living with HIV (including ARVs and nutritional support).

15. Please list the most common health problems observed within your region. The morbidity charts below detail the number of patients reporting to the outpatient department for various conditions. Only conditions with 10 or more reported cases are listed.

JULY Under 5 Over 5

Respiratory Illnesses: 160 Respiratory Illnesses: 156 Confirmed Malaria: 124 Confirmed Malaria: 117

Clinical Malaria: 37 Skin Infection: 51 Diarrhea: 33 Clinical Malaria: 41

Skin Infections: 16 Urinary tract infection: 39 Anemia: 15 Rheumatism/Joint pain: 24

Pneumonia: 19 Accidents: 15 Diarrhea: 15

AUGUST Under 5 Over 5

Clinical Malaria: 80 Clinical Malaria: 121 Respiratory Illnesses: 75 Respiratory Illnesses: 90

Confirmed Malaria: 44 Confirmed Malaria: 47 Skin Infections: 18 Skin Infection: 42

Diarrhea: 17 Urinary Tract Infection: 31 Diarrhea: 23 Rheumatism/Joint Pain: 20 Pneumonia: 10

SEPTEMBER Under 5 Over 5

Confirmed Malaria: 52 Confirmed Malaria: 57 Respiratory Illnesses: 52 Respiratory Illnesses: 46

Clinical Malaria: 35 Clinical Malaria: 43 Diarrhea: 26 Skin Infection: 42

Skin Infections: 15 Urinary Tract Infection: 39 Rheumatism/Joint Pain: 15 Diarrhea: 14

16. Notable project challenges and obstacles:

• Clinical staff turnover increased during Q3 because of a large recruitment campaign by government hospitals; the HR consultancy is exploring how LCA can better prevent turnover.

• A teachers’ strike delayed the start of school and school-based LCA programs for the entirety of September. LCA’s management and education teams developed programmatic options for keeping pupils occupied in case of strikes in the future.

• Microfinance provider, KIVA Zip, has discontinued its program in Kenya. LCA management is exploring other

microfinance options for community members. • The new staff housing construction project is still behind schedule, but the operations team and management

team are in close contact with the contractor to complete the construction in 2015. • LCA’s enrollment into the National Health Insurance Fund in Kenya has been delayed and is not likely to be

carried out until 2016. 17. If applicable, plans for next reporting period:

• Finalize renovation of the existing hospital building and shift clinical services upon completion; continue making progress on construction of the new staff housing.

• Onboard the new Executive Director, Ash Rogers, in December and January in both Kenya and the U.S. • Continue to train HIV services staff on point-of-care usage of the Kenya electronic medical records system,

including the registration desk, clinical teams, and the HIV care and support department. • Carry out a third week of holiday activities (“Better Breaks”) for at least 500 adolescents during their school break

in December. • Graduate in-school and out-of-school girls mentoring participants from the program and carry out end line

evaluations to better understand the progress made during the project period and to enable follow-ups and improvements for the 2016 program planning.

• Plan and implement an integrated HIV and WASH program for HIV affected households in the community; similar to the Thrive thru 5 program; community health workers will carry out home visits to families enrolled in the program and closely interact with the clinical staff to inform provision of proper medical care.

18. If applicable, summary of RMF/WCF-sponsored medical supply distribution and use: N/A

19. Success story(s) highlighting project impact

1. HOSPITAL EXPANSION UPDATE

The completed connecting wing of the hospital is fully operational. The clinical records department, cashier, and electronic medical records officer are operating from the new building. Well patient services are being offered in the new hospital building, including maternal and child health services, family planning, prevention of mother-to-child (HIV) transmission, and the new laboratory and pharmacy. The contractor and architect continue to make minor improvements around the building. The parking area is being finished and has been extended to the old hospital building to allow drop-off and pick-up of maternal and very sick patients. The drainage system is also being improved to allow proper flow of water during the rainy season. The existing hospital building renovation is ongoing, with new internal and external walls already in place. At the same time, the new staff housing is moving toward completion. Because of a slight delay in project activities for the staff housing, LCA’s Operations Team and LCA management are actively working with the contractor to move the progress forward to complete construction by the end of 2015.

The contractor turns over the keys of the new connecting wing at LCA Hospital to Robert Kasambala, Director of Hospital and Operations.

Mothers and babies waiting to be seen at the new maternal and child health offices of the hospital’s new connecting wing.

2. BENEFICIARY PROFILE: Emily

Emily Adhiambo Otieno, a community resident from Kuna Village, is married with five children. She and her family attend church some ways down the road from her house and spend a good portion of time at church on Saturdays as services can last over four hours. Several months ago, Emily stopped bringing her young children to church with her because the children would need to relieve themselves, but there was no latrine at the church.

Emily attended a WASH (water, sanitation and hygiene) training earlier in the year, which was what triggered Emily to make the decision to leave her children at home during church where they had access to proper sanitation. She realized that disposing of feces openly, even if it was not at their

home, was improper and likely to spread germs around the community. She figured it was better for her children to stay home than be exposed and expose others to diseases.

But Emily did not stop at her own family. Instead she requested for the WASH Advocates in her community to assist the church in creating a better environment for all of its members. The WASH Advocates organized an Action Day, where community members came together to construct a latrine within the church compound. The WASH Advocates also provided education to all in attendance on proper WASH behaviors and how to maintain the new latrine.

Now the church proudly boasts a latrine and Emily has started bringing her children to church again. The members of the church were very grateful to the WASH Advocates. Now, Emily has even joined many of the events held by the WASH Advocate group in her community to promote full latrine coverage and improved WASH behavior at every household.

3. BENEFICIARY PROFILE: Joseph

At the age of 40, Joseph Asudi is married and has 14 children – 8 are still in school. This husband and father strives to provide a good life for his family and education for his children through agriculture.

Although Joseph is an experienced farmer, his road to increased productivity has had many challenges. In the past, Joseph’s farm often suffered from poor crop yields due to a lack of money to purchase pesticides and fertilizers. As a result, his crops died from disease, forcing him into a cycle of unstable and insufficient income. Joseph also believed agriculture was a seasonal activity, due to his understanding of growing sugar cane, and was often frustrated with his inability to afford tuition fees for his children during the low seasons.

But, a turning point for Joseph and his family came in early 2014. Joseph joined the Kuna Micomucs table banking group, where members receive financial training, including mechanisms for group savings and individual credit building and business management from the Lwala Community Alliance Economic Development Team.

They also attend regular meetings, interact and exchange ideas with one another and support each other in times of grief. Micomucs is one of the many adult groups sponsored by Lwala Community Alliance’s partner Development in Gardening. DIG aims to empower communities through agricultural and financial training. This group meets weekly to learn about loans, debt management, and basic financial skills in business. Having been educated in the ways and importance of saving, Joseph is ensuring a savings culture is passed onto his children. And, he now earns an income selling a variety of produce from his farm, including bananas, ground nuts and vegetables. “Currently, I have more than 200 banana stems, which is the main source of income for my family,” he said. Joseph is encouraged and motivated by the improved crop yield and enjoys ploughing his farm and watering his plants with the hope that enhanced productivity will continue. His table banking group has not only empowered Joseph and his family with increased knowledge and improved agricultural output but has also enabled him to purchase higher quality seeds and fertilizer with the loan he receives from the group. This has helped increase soil fertility and productivity on Joseph’s farm as well as dramatically improved the health and quality of life for him and his family. As Joseph continues to grow as a farmer, father, and husband, he feels empowered and is more confident that his knowledge will benefit his family and the community at large.

III. Financial Information

Detailed accounting sent separately each month.