2020 Annual Report

Dear Friends,

As an organization, we are deeply committed to community-led development. This means undoing colonial mentalities in health care that create distance between health provider and client and amplifying the voices of community groups to drive their own development. This year, more than ever, we've witnessed the power of community action. From removing barriers to care caused by COVID-19 lockdowns, to advocating globally for PPE, to dispelling misinformation, our community members have been on the frontlines of fighting the COVID-19 pandemic.

In March of 2020, we set goals to guide our pandemic response: protect health workers, maintain essential health services, stem the spread of the virus, and shield the vulnerable from socio-economic shocks. To meet these goals, we made big pivots in work plans and audaciously expanded our budget by over 1 million dollars. We asked our communities, facility staff, community health workers, and donors to take this big leap of faith with us. Because of their stalwart support, Lwala provided guidance on protocols, training, personal protective equipment, drugs, routine testing, mental health counseling and digital tools to thousands of frontline workers. And, we allied with the Ministry of Health to launch a cadre of COVID-19 contact tracers and contact monitors. So when the pandemic surged in Kenya in late 2020, we were able to stand by our health workers while continuing to serve our clients. The years of work we've put into bolstering the health system meant that, despite unprecedented challenges posed by COVID-19, we actually saw improvements in maternal, child, reproductive and HIV health outcomes. We are proud to share this progress with you in the next pages.

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 support from allies like you.

Thank you for standing with us!

Ash Rogers
Co-Chief Executive Officer

Julius Mbeya
Co-Chief Executive Officer

01

COVID-19 Response

Leveraging the Community-Led Health Model to Respond to COVID-19

Lwala's proactive response focused on protecting health workers, maintaining essential healths services, stemming the spread of the virus, and shielding the most vulnerable from the pandemic's socio-economic shocks.




02

Community Health Workers

Extending High-Quality Care To Every Home

Traditional midwives are the main competitors to a safe delivery in Kenya. When supported as professionalized community health workers (CHWs), traditional midwives become powerful champions of maternal, child, and reproductive health. Unfortunately, traditional midwives are blocked out of many CHW cadres by discriminatory literacy and education requirements. Further, CHWs are too often unpaid and underequipped. Lwala is conducting research to demonstrate the effectiveness of these frontline workers when key investments are made in their professionalization.

STUDY HIGHLIGHTS ADVANTAGES OF PROFESSIONALIZED CHW's
A recently published peer-reviewed study compared Lwala professionalized CHW's to status quo CHW's. 1 It found that the professionalized cadre was:
  • Trained twice as frequently
  • Retained 40% longer
  • 5 times more likely to be knowledgeable of health danger signs
Importantly, formal education level was not a predictor of CHW knowledge. Lwala is leveraging this and other evidence to support policymakers to design more effective community health systems in Kenya and beyond.

1 Heerboth, S., Hennessy, C., Omondi, B., et al. (2020). 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. African Journal of Reproductive Health, 24(1), 121-132.

Lwala community health workers (CHWs) provide essential, lifesaving health services. They proactively visit households, track pregnancies, support facility deliveries, ensure on-time immunizations, test and treat common childhood illnesses, provide contraceptives, connect clients to health centers, provide health information, and dispel misinformation. In the face of COVID-19, Lwala retooled CHWs with: training, PPE, mental health counseling, and new digital tools. Lwala improved child health outcomes including immunization coverage, well-child visit coverage, and HIV care adherence despite the pandemic






CHILDHOOD IMMUNIZATION RATE


Percent 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.

03

Health Centers

LONG-TERM INVESTMENTS IN HEALTH FACILITIES LED TO CONTINUED ACCESS TO CARE

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.



HEALTH FACILITY ASSESSMENT SCORES
2018-2020


Years of progress across our network of facilities means that our clients have multiple safe choices for health services. When COVID-19 cases surged, causing some facilities to reduce services, community health workers were able to divert clients to nearby facilities and sustain access to quality care.


Skilled Delivery Rate


Percent of live births delivered with a skilled health worker.
All actively served areas are reported.
1.  Kenya National Bureau of Statistics. (2015). Kenya Demographic and Health Survey: 2014. Nairobi, Kenya, Rockville, MD, USA

04

Obstretic Hemorrage Initiative

Scaling Lifesaving Technologies For Mothers

Obstetric hemorrhage - uncontrolled bleeding - is the leading cause of maternal death in Kenya. Lwala partners with the Ministry of Health to deploy the low-cost technology of the non-pneumatic anti-shock garment (NASG). This technology has been shown to reduce maternal mortalities related to obstetric hemorrhage by 67%.1 We bundle the non-pneumatic anti-shock garment with other lifesaving approaches - uterine balloon tamponade, uterotonic drugs, uterine massage, and blood transfusion - to create an easy-to-incorporate package for health workers to deliver.

1.  Mbaruku, G., Therrien, M. S., Tillya, R., Mbuyita, S., Mtema, Z., Kinyonge, I., Godfrey, R., Temu, S., & Miller, S. (2018). Implementation project of the non-pneumatic anti-shock garment and m-communication to enhance maternal health care in rural Tanzania. Reproductive health, 15(1), 177.




05

Contraceptive Access

Applying Research to Advance Sexual and Reproductive Health

When women and girls have the tools to choose when they get pregnant, the result is healthier and more prosperous communities. Lwala increases confidential, voluntary access to sexual and reproductive health services, while challenging harmful gender norms and increasing buy-in for reproductive rights. Lwala starts by training community committees, men's groups, community health workers, and youth advocates. Each of these groups plans and launches reproductive health initiatives to educate their neighbors, distribute and promote contraceptives, and address cases of abuse. We provide a full range of contraceptive options through a variety of access points including health facilities, youth centers, village-level outreaches, and directly to homes.

STUDY SHOWS INCREASED CONTRACEPTIVE PREVALENCE

A peer-reviewed study of contraceptive prevalence used regression analysis to identify factors associated with increased contraceptive use.1 The study compared Lwala communities alongside four similar locations and found that living in a Lwala community significantly increased the odds of using a contraceptive method. Importantly, this study also gives Lwala and the Kenya Ministry of Health more insight on how to target our most vulnerable populations, especially younger people.

1.  Moon, T., Okoth, V., Starnes, J., Opiyo, E., Ressler, D., Mbeya, J., & Rogers, A. (2020). Determinants of modern contraceptive prevalence and unplanned pregnancies in Migori County, Kenya: results of a cross-sectional household survey. (submitted manuscript)

Couple Years of Protection

A Measure of Contraceptives Provided Based on the Number of Years of Pregnancy Prevention

06

HIV Care

Developing Innovations in HIV Care Delivery

Lwala supports community members living with HIV by providing comprehensive HIV care through health centers and community health workers (CHWs). And, we partner with support groups of people living with HIV and their allies as they launch community initiatives promoting health and development. With COVID-19 as a particular threat to this immunocompromised population, Lwala worked with support groups and CHWs to expand the number of clients receiving HIV drugs and clinician visits directly in their home. As a result, we nearly eliminated appointment defaults and saw all-time high rates of clients effectively suppressing the virus.

HIV Default Rate



Percentage of Clients on HIV Care Missing Appointmet by 2+ Weeks

HIV Viral Suppression



Percent of Clients on HIV Care With Suppressed Viral Loads

07

Youth-Led Health

Developing Innovations in Youth and Adolescent Health

Youth Peer Providers are young people empowered to launch their own initiatives and deliver health information and condoms to their peers. To reduce barriers to accessing contraceptives caused by COVID-19, Lwala added emergency contraceptive pills to Youth Peer Providers' service package. During this learning pilot, we conducted extensive focus groups to understand youth perceptions and preferences and tracked contraceptive uptake compared to baseline. Based on the success of this pilot, we plan to incorporate emergency and oral contraceptive pills as a standard offering of Youth Peer Providers.

08

Early Childhood Development

Advancing a Holistic Approach to Child Wellbeing

In 2020, Lwala integrated the Nurturing Care Framework into our community-led health model.1 As community health workers (CHWs) visit households they provide training and support to caregivers on maternal & child health, nutrition, sanitation, and responsive and skillful parenting. Caregivers are supported to obtain child birth certificates and enroll their children in the National Health Insurance Fund, both essential steps to placing children on a path to success. Through parenting support groups, CHWs provide information on child protection and support caregivers to use locally available materials to develop toys and picture books as tools for a child-centered approach to early learning.

1.  World Health Organization, United Nations Children's Fund, World Bank Group. Nurturing care for early childhood development: a framework for helping children survive and thrive to transform health and human potential. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO.