Issue 2, April 2013

Together for Better Health in Western Kenya

Retired midwives recruited to increase skilled deliveries
The APHIAplus Western Kenya Project is collaborating with the Ministry of Public Health and Sanitation (MOPHS) in recruiting and building the capacity of midwives who had previously retired to increase the availability of skilled birth attendants in the community. This is in response to the high number of women delivering at home or with unskilled attendants in the region. The Kenya Demographic Health Survey of 20082009 indicated that only 26% of expectant women in Western Province and 45% in Nyanza Province delivered with the help of a skilled attendant. Midwives serving in public health facilities typically retire at 55 to 60 years of age when many are still strong enough to continue providing services. Through the projects support, identified midwives are taken through refresher courses and updates on current practices of safe delivery. This includes care for HIV-positive women. The midwives also receive needed equipment, such as a delivery bed, delivery kit, gloves, surgical blades, water treatment kit, and reporting tools. We lose many mothers who opt to deliver at home because traditional birth attendants are not skilled enough to manage serious complications that occur during labour, says Amina Baraka, nurse-in-charge of Matete District Hospital in Kakamega County of Western Province, with frustration written all over her face.

Deliveries

Geraldine Nyongesa attending to some of her clients at her home But the domiciliary midwives initiative supported by APHIAplus is making a big impact on the lives of mothers and children in this area, she says. Through the midwives, we have managed to cut down on the number of mothers and children who die due to child birth. Mothers are freer with these domiciliary midwives, and so they flock to their homes when labour beckons. Through this initiative, the project has trained and equipped more than 270 domiciliary midwives in the region. Last year, the midwives delivered more than 3,450 women. No maternal or perinatal deaths were reported under the supervision of the midwives. Geraldine Nyongesa, 68,retired from public service eight years ago and is now a domiciliary midwife supported by the project. She says, I used to go to these womens houses to assist them, but with time, their numbers kept on increasing, and this prompted me to turn my sons simba (bachelors hut) into a maternity room.

Inside this Issue

The simba that Geraldine Nyongesa turned into a maternity room

Although her make-shift maternity ward is not what one would find in a health facility, she has set aside two beds where the women lie before and after delivery. For any woman who wishes to conform to the cultural norm to bury the placenta at home, the project has also provided a special polythene carry bag to allow for hygienic transportation of the afterbirth back home for burial.

Inside this issue

Project-supported orphans and vulnerable children get wings to fly...pg 2 Mother protects her daughters from undergoing The Cut...pg. 3 APHIAplus 2012 achievements...pg. 4 Happiness at last...pg 6 Pictorials...pg 7

Project-supported orphans and vulnerable children get wings to fly

Hellen Owuor, a 14-year-old vulnerable child supported by APHIAplus Western Kenya, defied poverty and all other odds to score 400 marks out of the possible 500 in last years Kenya Certificate of Primary Education examinations. With parents who are both HIV positive and no steady source of income, she feared losing her opportunity to pursue secondary education in a National School. Even though I got a calling letter from Kenya High School, thoughts of losing the chance and joining a local day school crossed my mind because of poverty, says Hellen. Hellen is among 43 pupils supported by APHIAplus Western Kenya who benefited from Wings to Fly, an initiative of Equity Bank that supports orphans and vulnerable children with school fees, shopping money, pocket money, and fare to and from school for the four years of secondary education. Equity Bank Kisumu manager Kuyo, speaking during the presentation of the scholarships at Kisumus sports grounds, said that this initiative is aimed at moulding future leaders and ensuring that children from poor backgrounds receive a chance to pursue their dreams. Kuyo urged the beneficiaries to continue working hard, promising best performers continued support up to the university level and even employment thereafter. Hellen Owuor outside her home Hellen lives with her parents in a one-room house in Ombo Kawere village, Migori County. She attended St. Cecilia Olare primary school, where she emerged top with a sterling performance that had not been registered in the school before. Having been identified for support through the Dago Dala Hera community-based organization, Hellen benefited from payment of school levies, school uniforms, and other support from APHIAplus Western Kenya. The project also pays school fees for other students in secondary schools.In 2012, the project paid school levies for 37,501 orphans and vulnerable children to enable them to continue their schooling and provided school uniforms to more than 60,000.

Even though I got a calling letter from Kenya High School, thoughts of losing the chance and joining a local day school crossed my mind because of poverty.

National Organization for Peer Educators (NOPE) profile

National Organization for Peer Educators (NOPE) implements a workplace program intervention (WPI) that contributes to APHIAplus Western Result Area 3 to ensure increased use of quality health services, products, and information in the public and private sectors. It focuses on improving and expanding availability of high-impact, high-quality health services at facility and community levels, increasing the demand for those services, and improving health-seeking behaviors in the communities. The WPIs mandate is to create demand for service uptake in all three intervention areas while building partnerships and networking with APHIAplus partners and other relevant stakeholders. NOPEs WPI covers Nyamira County, Migori County, Kisumu County, and Siaya County. The program has established partnerships through memorandums of understanding with 15companies and 6 institutions of 2 higher learning.

Rianyamwamu peer educators demystifying condom size through a small-group activity S Continued on page 3

Mother protects her daughters from the Cut

Female genital mutilation (FGM) has significantly declined in Nyamira region and may soon be a thing of the past. However, a few parents still force their daughters to be circumcised secretly. These parents organize for circumcision during the night with no celebrations that may raise eyebrows and lead to their arrest, since FGM has been declared illegal by the government. To address this problem, the APHIAplus Western Kenya project, in partnership with the local Seventh Day Adventist Church, has educated the community on the harmful effects of FGM. Community members are then encouraged to enroll their daughters for an alternative rite of passage that is held annually. Dorcas Nyaboke, a mother of three girls, had undergone the training. She decided not to allow her three daughters (Vane, Joyce, Winnie) to be circumcised.However, Dorcass husband still believed in female circumcision and invited a traditional circumciser without her knowledge, with the whole process to take place at night. When Dorcas saw the circumciser accompany her Dorcas and her daughters husband to their home, she knew without being told what their . intention was. The community members supported her and threatened to beat up the circumciser who upon sensing danger decided to run for her dear life. I She shouted, attracting a large crowd of people to their homestead, want my daughters to be role models and achieve the very best education. and insisted that her daughters would only be circumcised over her Says Dorcas with firmness in her voice. dead body. It took her a period of time to convince her husband that FGM was not good for girls. They have now agreed not to circumcise their daughters and have decided to enroll them for the alternative rite of passage. The girls are happy that their mother saved them from the pain and other effects of circumcision. Vane, the eldest and in class six would like to be a teacher and teach more parents and girls the effects of FGM, while Joyce is aspiring to be a nurse. In December 2012, a total of 600 girls aged between 6 and 22 years went through alternative rite of passage after a weeklong seminar at Tombe secondary school, Nyamira.

Continued from page 2

S Strategies and approaches for the WPI are outlined below:

NOPE profile

Advocacy for management buy-in: 136 heads of departments in 20 workplaces have participated in advocacy meetings that have led to strengthened management support across the board. Institutional capacity assessments: 20 organizations have been assessed to identify gaps in workplace programming. Coordination structures: 27 focal persons and coordinators have been trained and 17 steering committees have been established to date. The trainings increase the members capacity to manage and coordinate comprehensive and sustainable workplace programs . Peer education/health activism: 18 workplaces have had employees from different departments trained as peer educators using the standard peer education curriculum. Additionally, the program has inculcated the SPLASH Inside Out module that aims at creating health activism. A total of 251 peer educators (140M, 111F) have been trained. Their main responsibility is to introduce health activism at their places of work by conducting informal health education/peer education sessions. A total of 60,263 condoms have been distributed so far through these sessions. Integrated outreaches: The WPI has conducted integrated outreaches at workplaces to provide health-related services to employees. Services include HIV testing and counseling, tuberculosis screening, screening for sexually transmitted infections, cancer screening, and family planning. 3

APHIAplus Western Kenya 2012 achievements

.

For the year 2 reporting period ending December 2012, the project
supported 696 health facilities in various service delivery areas, and these were linked to 391 project-supported community units. District health management teams (DHMTs) from 52 districts were supported to conduct integrated supportive supervision, district stakeholder forums, and annual work plan reviews and for national days/activities. The project has built on the gains made since project inception in January 2011 to enroll 53,385 active HIV-positive clients on ART by the end of Year 2. All received a minimum package of HIV services. VMMC performance trends, Nyanza and Western provinces, JanDec 2012

Source: Minor Theatre Registers, 2012 Support for reproductive health saw improvements. For example, the percentage of pregnant women attending four ANC visits was 50% at the end of Y2 compared to 38% at the beginning of the year. The project rolled out cervical cancer screening services and reached 15,639 clients, and this screening will be scaled up in the coming year. Under the family planning component, the couple years protection (CYP) has continued to improve steadily to a cumulative total of 451,384, a 59% increase in Y2. To promote hygiene among school children, hand washing facilities were provided to 65 primary schools. During the Global Hand Washing Day celebrations on October 15, 2012, more than 13,000 children used these facilities. Through the Mama SASHA project that promotes the consumption of orange-fleshed sweet potatoes that are rich in vitamin A, 1,769 pregnant women attending ANC visits in the project area received the potato vines. CHWs with nutritional assessment tools reached at least 11,000 children under 5 years for community-based growth monitoring, and those with malnutrition were referred to health facilities for management. Comparison of immunization coverage in selected districts in Nyanza and Western provinces, 2012 vs. 2011

Clients undergoing HIV testing and counseling at Nyamira District Hospital Comprehensive Prevention of Mother to Child Transmission (PMTCT) services were offered at all project-supported PMTCT sites, with 139,417 pregnant mothers being counseled and tested at ANC visits, reaching 78% of the Y2 target. Almost all pregnant mothers (>95%) found to be HIV positive were linked to care for prophylaxis (both maternal and infant) and/or ART treatment. The MTCT rate at 18 months for Western Kenya is 8%, compared to the national rate of 10%. The MTCT rate for the project area is expected to decline further in the coming year with scale-up of an integrated MCH model to minimize missed opportunities in the PMTCT/EID cascade. For HTC services, 546,427 clients were reached (88% of Y2 target), with 58% through PITC. 62% of HIV positive clients were linked to care through documented and escorted referrals. CHEWs, CHWS, and peer educators will support referrals and follow-up of clients who have tested HIV positive but are not yet in care. The project continues to support provision of routine TB diagnostic screening and treatment, including MDRTB support. It also supports a robust school health TB program that reached 585,530 children in 1,069 schools across the project area with TB messages. In high HIV prevalence areas in non-circumcising communities, the project supports Voluntary Medical Male Circumcision (VMMC) services as a strategy for HIV prevention. The project reached 35,099 males through both static health facilities and mobile outreaches utilizing the MOVE (Model for Optimizing Volume and Efficiency) strategy.

Source: District Health Information System 2

APHIAplus Western Kenya 2012 achievements

To address gender-based violence (GBV) at community level, 26 GBV victims were supported to access legal services. Getting legal support has been a major challenge for most GBV survivors in the region. Addressing social determinants of health This support revolves around addressing factors that affect the health of orphans and vulnerable children (OVCs) in the project area. Key support included the following: School levies for 37,501 OVCs to enable them to continue their schooling uninterrupted. School uniforms were provided to more than 60,000 OVCs. 49,800 OVCs were supported with birth registration, and 670 houses for very needy OVCs were renovated. More than 3,000 guardians of OVCs were trained on kitchen gardening and production, use, and storage of drought-tolerant crops. Caregivers received more than 20,000 fruit seedlings (passion, mangoes, pawpaw, pineapples and tissue culture bananas).

APHIAplus program officer, Alfred Ochola demonstrating to pupils , how to wash hands Through the PD hearth program, APHIAplus screened 3,976 underfives and 786 underweight children enrolled for rehabilitation. Of the enrolled children, 602 successfully graduated after gaining at least 400 gm. Supporting the community health strategy The project provides key support for rollout of the Ministry of Health s community health strategy. Through this strategy, communities are empowered to practice healthy behaviors and seek prompt treatment for illnesses in health facilities. During 2012, the project provided 28 motorcycles to health care workers to assist in community supervisory activities. The process of procuring more than 6,000 bicycles for use by community health workers in ongoing. Community HIV prevention interventions targeting most-at-risk populations reached more than 60,000 people through peer education sessions. More than 570,000 condoms were distributed through these sessions, and at least 13,000 referrals were made for medical services.

Tomatoes harvested from a greenhouse supported by APHIAplus under Kagwa community-based organization

To ensure that guardians of OVCs are empowered economically in a sustainable way, the project continued supporting them to initiate income-generating activities. By the end of the year, the guardians had formed 118 village savings and loan associations. The households use loans from the groups to start smallscale farming and small-scale businesses, purchase food, and access basic health services. The project also procured 48 greenhouses for the OVC caregivers. To provide clean water to OVC households, the project supported the protection of 23 water springs during the year. This work benefited more than 7,000 households. To improve sanitation and hygiene, 131 of 488 villages were declared Open Defecation Free, and a steady reduction in diarrhea cases was noted.

). Rikka Trangsrud, director of PATHs Kenya Country Program, handing over motorbikes to an MOH official in Western Province

Happiness at last
I used to go to REEP to ask
for food and life was very difficult back then, but today I visit them to deliver my orders for bananas and seek extra information on how to

improve my banana
business.
Janet Ndubi displays bananas she has harvested from her farm Meet 40 year old Janet Ndubi, who hails from Butula District in Western Province. She is among a group of 24 women living with HIV who were trained on table banking (village savings and loan project) and how to grow drought-tolerant crops. The APHIAplus Western Kenya project provided the training through the Rural Education and Empowerment Program (REEP) CBO. The group started its own merry-go-round and Janet took a loan which she used to start banana farming. For a bunch of bananas, Janet gets around 2,980 shillings. I used to go to REEP to ask for food and life was very difficult back then, but today I visit them to deliver my orders fo r bananas and seek extra information on how to improve my banana business, says Janet. We were taken for training on how we can grow crops which do not require a lot of rain , such as sorghum, cassava, bananas and sweet potatoes. Later on, after we chose banana farming, we went for a follow-up training on how to take care of our bananas and how to control the diseases that could affect them. We got the seedlings through REEP CBO and we are doing well so far. I now pay school fees for my children without having to depend on anyone. Thanks to APHIAplus project! she adds.

Janets banana farm

Janet, her daughters and grandson outside their home

Pictorials

CAPTIONS 1. Members of Chwele shiners magnet theatre group display how to use a condom 2. 52-year-old Mary Atieno thanking APHIAplus for supporting adult education for caregivers in Butula, Busia 3. A school pupil quenching his thirst at a water spring supported by APHIAplus 3 4. Chief of party Dr. Ambrose Misore presenting bicycles to Chiga community unit, Kisumu County 5. A clinician attending to an expectant mother during an outreach at Kombato Community Unit in Nyatike

Editorial Team
Rael Odengo Mark Okundi Celestine Asena Juma Mwatsefu Dr. Mukabi James Cornelius Kondo Wamalwa Masibo Dr. Edward Kariithi Oby Obyerodhyambo Graphic designer: Victor Oriedo

This Newsletter is made possible by the generous support of the American People through the United States Agency for International Development (USAID) under the terms of Cooperative Agreement number AID-623-A-11-00002. The contents are the responsibility of PATH and do not necessarily reflect the views of USAID or the United States Government. Copyright 2013, PATH. All rights reserved.

Contributors
Dr. Ambrose Misore Rikka Trangsrud

Kakamega Office Kenafya building, Okwemba Road P.O.Box 1330-50100, Kakamega - Kenya Cell: +254 723 990 242 Bungoma Office Tel: +254 055 30394

Kisumu Office Mega City, Mezzanine Floor along Nairobi Road P.O. Box 19128-40123, Kisumu Kenya, +254 070 213 149 Migori Office +254 020 2337186

Email: info@aphiapluswesternkenya All rights reserved APHIAplus Western Kenya @2013