2018 Annual Report

Dear Friends,

In 2018, we took a bold step in expanding our impact, doubling the population we serve. This is part of a larger effort to build a model county of community-led health, transforming how the 1 million people in Migori, Kenya access healthcare, and ultimately influencing the health system at-large.

We are driven to reach more communities facing the challenges of a struggling health system by one of our core values, neighborliness.

When our founders, Milton and Fred, got the opportunity to study in the US, it was their neighbors that sold chickens and goats to send them to Dartmouth. And when they returned to fulfill their father's dream of building a hospital, it was their neighbors who oversaw the blueprints, donated land, and dredged sand to make it possible.

Over twelve years, we've built a holistic health model that is driven by the power of neighbors banding together to make change. The relationship between communities and their health care system is changing - and with it, health outcomes are improving. This year, we published a peer-reviewed study in a scientific journal, PLOS One, that shows a significant decrease in child death in Lwala communities. This next year, we will continue to expand our direct reach to a population of 90,000. And we'll remain at the forefront of policy change with the Ministry of Health, to secure health care for all.

All of this is possible through the support of our neighbors and partners, like you. Thank you for standing with us!

In solidarity,

Ash Rogers
Executive Director

Julius Mbeya
Managing Director

01

Child Health

Ensuring every child celebrates a 5th birthday

Digitally empowered Community Health Workers enroll every child at birth, track child growth, and ensure on-time immunizations. They provide home-based screening and treatment for the most deadly childhood conditions, including malaria, pneumonia, malnutrition, and diarrhea. Community Health Workers also connect children to local health clinics. Lwala works with community members and government to ensure these local clinics have the resources, training, and systems to provide quality care - making certain that no child slips through the cracks.

A peer-reviewed study of under-five mortality was published in 2018 in the journal PLOS One. Results show that prior to Lwala's intervention 105 children under 5 died for every 1,000 live births. From 2012 to 2017 that rate dropped to 29.5 deaths per 1,000 live births. 1

While not directly comparable, Lwala's rates outperformed the most recently reported under-5 mortality rates for our region, Nyanza Province (82 per 1,000) and for Kenya as a whole (52 per 1,000). Lwala is within reach of the Sustainable Development Goal of 25 deaths per 1,000 live births.

1 Starnes JR, et al. Under-five mortality in the Rongo Sub-County of Migori County, Kenya: Experience of the Lwala Community Alliance 2007-17 with evidence from a cross-sectional survey. Public Library of Science. 2018:13(9).

IMMUNIZATION RATE

SPECIFIED CHILDREN WHO RECEIVED ALL TYPES OF VACCINATIONS
Kenya Demographic Health Survey (2014)

02

Maternal Health

Unlocking the lifesaving power of traditional midwives

Central to our model is the recruitment of traditional midwives. These women have delivered healthcare to their communities for generations. But, because traditional midwives have been cut off from the formal health system, these births are often dangerous for mothers and babies.

We leverage the deep connections of these midwives and train, pay, supervise, and digitally empower them as professionalized Community Health Workers. Lwala Community Health Workers identify pregnant women as they proactively visit homes. Then, they link mothers to the formal health system by identifying symptoms of high-risk pregnancies, ensuring adequate maternal nutrition and supporting safe delivery at a facility. They also follow-up on postpartum care, provide breastfeeding support, and counsel new mothers on a range of contraceptive options.

We transform these midwives from the greatest competitors of skilled delivery to the formal health system's greatest champions.

1 Heerboth S, Hennessy C, Omondi B, Moja M, Mbeya J, Rogers A, Ressler D, Davidson M, Moon T. Knowledge of Obstetric and Neonatal Danger Signs among Community Health Workers in the Rongo sub-County of Migori County, Kenya: Results of a community-based cross-sectional survey. 2018. (Unpublished Manuscript)

PERCENTAGE OF SKILLED DELIVERIES

LWALA PRE-2011 - 2018
Kenya Demographic Health Survey (2014)

03

Reproductive Health

Working with communities to promote healthy timing and spacing of births

When women and couples have the tools to choose when they get pregnant, the result is better health outcomes for mother and child. Lwala understands that while women and girls may have a desire to access reproductive health services, relatives and community leaders are often the gatekeepers to these services. Thus, we increase confidential access to services, while challenging social norms and increasing buy-in for reproductive rights.

We start by training and empowering community committees, male forums, Community Health Workers, and youth advocates. Each of these groups plans and launches their own reproductive health initiatives to educate their neighbors, distribute and promote contraceptives, and confront cases of abuse.

CONTRACEPTIVE PREVALENCE RATE

PERCENTAGE OF WOMEN USING CONTRACEPTIVES
Kenya Demographic Health Survey (2014)
MEASURE Evaluation Pima (2016)
Lwala Community Alliance Household Survey (2017)
Lwala Community Alliance Household Survey (2018) unweighted data, subject to change.

COUPLE YEARS OF PROTECTION

A MEASURE OF BIRTH CONTROL PROVIDED, BASED ON THE NUMBER OF YEARS PREGNANCY PREVENTION IT PROVIDES

04

HIV Care and Prevention

Building an HIV-Free Generation

Lwala's comprehensive HIV programming empowers people living with HIV to lead healthy, productive lives, while eliminating new infections. All HIV-positive individuals and their allies are encouraged to join a program called HAWI ("Good Luck" in Dholuo). HAWI groups are trained in critical health topics and community organizing. Participants provide psychosocial support to each other and launch health initiatives in their communities. Each participant in HAWI is also regularly visited by a Community Health Worker.

05

Water, Sanitation & Hygiene

Igniting community action for safe water

Improved sanitation has been shown to reduce diarrhea morbidity by 38%. To achieve this, Lwala activates community committees who lead their villages in constructing latrines, building handwashing stations, and securing water sources. If a household is unable to build their own latrine, their neighbors step in to get the job done. Once villages are declared open defecation free, we work together to secure safe water.



WATER TREATMENT

PERCENTAGE OF POPULATION TREATING WATER PRIOR TO DRINKING
1 Kenya Demographic Health Survey (2014)
2 Lwala Community Alliance Household Survey (2017)

06

Nutrition

Investing in the long-term impact of nutrition security

Adequate nutrition during the first 1,000 days between conception and a child's 2nd birthday is one of the best investments in a child's health, education, and wellness.

Lwala provides preventative support to all pregnant women and young children, screens for vulnerability, and provides a holistic package of support to get families on a long-term path to nutrition security.

BUILDING A LADDER TO NUTRITION SECURITY

07

Clinical Quality Improvement

Supporting patient-centered health centers

Lwala unites community members and health care workers to improve health facility performance in the 6 key areas of healthcare delivery.

    • 1. Service Delivery
      2. Health Workforce
      3. Health Information Systems
      4. Access to Essential Medicines and Supplies
      5. Financial Management
      6. Leadership and Governance
  • 08

    Lwala Community Hospital

    Standing as a Center of Excellence

    09

    Education

    Educating girls as a powerful lever of community health

    For every year a girl remains in school, the likelihood of an unwanted pregnancy or HIV infection decreases. And, studies show that children of educated moms have better health outcomes.

    We work with 13 government primary schools, partnering with communities to launch their own solutions and advocate within the education system.

    REACHING GENDER PARITY IN PRIMARY SCHOOL COMPLETION RATES