2019 Annual Report

Dear Friends,

In 2019, Lwala provided holistic support to more families than ever before, expanding to a new site and reaching a population of 90,000. At Lwala Community Hospital, our team took on an ambitious quality improvement effort to improve newborn care and drove a 61% reduction in perinatal deaths. Across our partner health facilities, we provided mentorship and support, leading to a 26% improvement in health quality. We grew our cadre of Community Health Workers, who are 5 times more likely to be knowledgeable of danger signs in pregnancy and early infancy than status quo community health volunteers.

At the health systems level, we expanded our obstetric hemorrhage initiative across Migori County and worked towards its inclusion in the national emergency obstetric curriculum. We supported Migori County to start codifying key community health policies, including payment, training, and dedicated supervision of Community Health Workers. Globally, we are engaged in the wider movement for universal health coverage. Through the Community Health Impact Coalition, we authored global tools, launched coordinated research, and extended our insights far beyond Kenya.

All of this work is made possible by the resolve of our communities, grit of our health workers, vision of our government partners, ambition of our staff, and solidarity of our supporters like you

Thank you for standing with us

With gratitude,

Ash Rogers
Executive Director

Julius Mbeya
Managing Director

01

Child Health

Ensuring every child celebrates a 5th birthday

Digitally empowered Community Health Workers enroll all children 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, health workers, and government to ensure these local clinics have the resources, training, and systems to provide quality care from conception to adulthood - making certain that no child slips through the cracks.

Results in a peer-reviewed study published in 2018 show a reduction in under-5 mortality following Lwala’s intervention .1 A follow-on survey collected 18 months later found a similar under-5 mortality rate of 29.4 deaths per live births in Lwala Communities and a rate of 36.5 deaths per 1,000 live births in comparison sites. 2 This adds to the evidence that children in Lwala communities are more likely to survive childhood.

1 Starnes J.R., Chamberlain L., et al. (2018). 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. PLoS One, 13(9).
2Lwala Community Alliance Household Survey Report. (2018-2019). Unpublished report.

IMMUNIZATION RATE



Percentage of children who received all specified vaccinations
1.  Kenya National Bureau of Statistics. (2015). Kenya Demographic and Health Survey: 2014. Nairobi, Kenya, Rockville, MD, USA.
3.  Lwala Community Alliance Household Survey Report. (2018-2019). Unpublished report.
 

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.

















2 Heerboth, S., Hennessy, C., Omondi, B., et al. (2018). Knowledge of obstetric and neonatal danger signs among community health workers in Rongo sub-county of Migori County, Kenya: Results of a community-based cross-sectional survey. (Submitted manuscript).






We leverage the deep connections of these midwives by combining them with status quo Community Health Workers and training, paying, supervising, and digitally empowering this new cadre as professionalized Community Health Workers. Lwala Community Health Workers identify pregnant women as they proactively visit homes in their village. Then, they link mothers to the formal health system, identifying symptoms of high-risk pregnancies, ensuring adequate maternal nutrition, promoting prenatal care visits, and supporting safe delivery at a facility. They also follow up on postpartum care, provide breastfeeding support, and educate 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

PERCENTAGE OF SKILLED DELIVERIES



LWALA PRE-2011 - 2019
Kenya National Bureau of Statistics. (2015). Kenya Demographic and Health Survey: 2014. Nairobi, Kenya, Rockville, MD, USA.

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



PERCENT OF MARRIED WOMEN USING CONTRACEPTIVES
Kenya National Bureau of Statistics. (2015). Kenya Demographic and Health Survey: 2014. Nairobi, Kenya, Rockville, MD, USA.
MEASURE Evaluation PIMA. (2016). Migori county family planning: January to June 2016. USAID, PEPFAR.
Lwala Community Alliance Household Survey Report. (2018-2019). Unpublished report.

COUPLE YEARS OF PROTECTION



A MEASURE OF CONTRACEPTIVE DISTRIBUTED BASED ON THE NUMBER OF YEARS OF PREGNANCY PREVENTION IT PROVIDES

04

HIV Care and Prevention

Building an AIDS-Free Generation

Lwala’s comprehensive HIV programming empowers people 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 support 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 regularly visited by their peers and a Community Health Worker.

05

Water, Sanitation & Hygiene

Igniting community action for safe water

Lwala activates community WASH committees who lead their villages in constructing latrines, building handwashing stations, and securing safe water. If a household is unable to build their own latrine, their neighbors step in to get the job done. As this happens, villages declare open defecation-free status, signifying community-wide sanitation. Next, WASH committees work to move up the sanitation ladder, upgrading latrine infrastructure and securing safe water sources.



WATER TREATMENT 1



PERCENTAGE OF HOUSEHOLDS TREATING WATER PRIOR TO DRINKING
1 Lwala Community Alliance Household Survey Report. (2018-2019). Unpublished report.

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 and breastfeeding women, young children, and people living with HIV and other chronic illnesses. We screen individuals for vulnerability and provide a holistic package of support to get families on a long-term path to nutrition security.

BUILDING A LADDER TO NUTRITION SECURITY

07

Improving Quality of Healthcare

Supporting patient-centered health facilities

Lwala unites community members and health workers to lead health facility management committees. Together, they implement a cycle of continuous improvement. Along the way, Lwala provides comprehensive assessments, coaching, training, and occasional resources to help facilities reach their goals of providing high-quality, patient-centered care.

26% average improvement in quality assessment scores


HEALTH FACILITY ASSESSMENT SCORES
2018-2019

As quality improved, Lwala’s partner facilities saw significant increases in patient visits, compared to similar facilities.


PERCENT CHANGE IN PATIENT VISITS
2018-2019

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, early marriage or HIV infection decrease. And, studies show that children of educated moms have better health outcomes.

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

GENDER GAP IN PERFORMANCE IS NARROWING, AS MORE STUDENTS PASS GRADE 8 EXAMS



STUDENTS PASSING GRADE 8 EXAMS