Over the past 15 years, Lwala has learned that improving health outcomes requires rebuilding trust. Imagine that early in your pregnancy, you travel 5 kilometers to your nearest health facility for antenatal care to check on the health of you and your baby. When you arrive, you have to wait hours in a crowded room, the nurse who sees you is rushed and rude, and you’re told that some of the tests you need are not available–so you’ll need to visit a different facility even further away. Now imagine this happens every time you seek health care for you or your family.
These experiences cause a breakdown of trust in the health system. For this reason, a central pillar of Lwala’s community-led health model focuses on engaging clients to drive improvements in their local health facilities. When people receive high-quality, dignified care, they are more likely to return again and again for lifesaving services.
Across a network of 10 partner facilities, Lwala brings together community members, facility-based health providers, and community health workers (CHWs) to rebuild trust. We work with these groups to conduct biannual assessments, which identify areas of progress and priorities for improvement. Armed with this information, facility teams develop and implement improvement plans, review outcomes, and make adjustments–ultimately improving the quality of health care.
The journey toward high-quality care at Ngere Health Facility
Ngere Health Facility, which provides services for about 6,000 people, joined Lwala’s quality improvement program in 2018. Soon after, Ngere reestablished its health facility management committee (HFMC), which brings together community members, facility staff, and CHWs to spearhead improvement projects. Over the next two years, Lwala supported the HFMC as they expanded the maternal and postnatal wards and provided clinical training for staff, translating to better care for patients.
Yet a number of challenges persisted: patients noted long wait times and a lack of privacy. The facility also lacked a laboratory and key supplies to test for malaria and HIV. During an early assessment of the facility, 67% of drugs were out of stock. This meant that patients who arrived at Ngere often had to go elsewhere.
One result of these challenges was a low rate of antenatal care–pregnant women in the area sought care elsewhere or skipped it altogether. After last years’ assessment showed declining scores, the HFMC and facility staff held an emergency response meeting. Together, they devised a plan of action to improve the quality of services. First, Lwala supported a training on focused antenatal care, which equips staff to detect pregnancy complications early. Ngere also converted unused staff housing into a temporary laboratory, where they could conduct antenatal care profiling, a series of tests that identifies risks to a mother and baby’s health. Meanwhile, Lwala helped fill gaps in missing test supplies at Ngere and other health facilities. Finally, Ngere began to offer free ultrasounds (Lwala provided the machine and the technician), and staff helped clients register for Linda Mama, Kenya’s free health insurance for pregnant women–both of which encouraged women to visit the facility. As a result, antenatal care visits at Ngere have increased by 40% since this time last year.
This translates to better care for women like Margaret, who went to Ngere for an antenatal appointment–she had heard they were providing tests and ultrasounds. With the new laboratory, staff were able to diagnose her with preeclampsia, a life-threatening condition that requires delivery at a hospital. Margaret delivered a healthy baby boy, and because of her confidence in Ngere’s health workers, she chose Ngere for all her postnatal visits.“I had a good experience, so I will continue to promote Ngere as a place of high-quality services and early detection,” she says. “I’m happy I can even walk here from my home.”
“I had a good experience, so I will continue to promote Ngere as a place of high-quality services and early detection,” she says. “I’m happy I can even walk here from my home.”
- Margaret, a nurse at Ngere Health Facility
Another success at Ngere was the establishment of a “waiting bay”–a covered, outdoor space with chairs where patients can wait. Ngere had seen increases in patient wait time and declines in patient satisfaction. The HFMC discussed strategies to reduce wait time, but was concerned this would compromise quality of care–each patient would have less time with a provider. Instead, they decided to construct a waiting bay to make patients more comfortable. After a training from Lwala on resource mobilization, the HFMC secured funds from local government for construction. As a result, there is a balance between waiting time (15 min) and consultation time (13 min), and 85% of patients now say the wait time is reasonable.
Today, Ngere’s overall quality scores are 2.6 times higher than 2018. When asked to attribute this success, Peter Ochieng, a clinical officer at Ngere, says, "The HFMC and staff have been trained to focus on projects with the greatest impact on the community.” The HFMC’s chairman Akal Azaria adds, “When the needs of the community are addressed, it makes me happy. A healthy relationship between the community and its facility is everything.”
“The HFMC and staff have been trained to focus on projects with the greatest impact on the community.”
- Peter Ochieng', a clinical officer at Ngere Health Facility
Improvements across Lwala’s 10 partner facilities
Beyond Ngere, the most recent facility assessment showed gains across Lwala’s 10 partner facilities. Since the beginning of this work in 2018, we’ve seen a 79% average improvement in quality of care. This requires constantly identifying new challenges–and working with facilities and communities to implement solutions.
Over the past year, for example, an important focus has been ending drug stockouts. First, facilities have improved their inventory management, including the removal of expired drugs, and HFMCs have been trained to track stock levels. Lwala also supported the transfer of commodities from facilities with an oversupply to facilities with a limited supply. Recognizing this is a systemic issue, Lwala is working with VillageReach and the Ministry of Health to develop a system that tracks commodity levels, which will improve reallocation and procurement. While progress remains, we have seen stockout rates at our partner facilities decline from 52% in 2018 to just 13% today.
“When the needs of the community are addressed, it makes me happy. A healthy relationship between the community and its facility is everything.”
- Akal Azaria, chair of Ngere's Health Facility Management Committee
The community-led health model recognizes that there is no single solution to improve health outcomes–and address decades of inequities–alone. But when CHWs reach every household, community health committees tackle problems affecting their neighbors, and health facilities improve the quality of their services, we see the health of communities transform.
