Post on 03-Jan-2016
Retired midwives recruited to increase
skilled deliveries
Deliveries
Issue 2, April 2013
Together for Better Health in Western Kenya
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 2008–2009 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 project‟s 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.
Inside this Issue
The ‘simba’ that Geraldine Nyongesa turned into a maternity room
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 women‟s houses to assist them, but with time,
their numbers kept on increasing, and this prompted me to turn my
son‟s simba‟ (bachelor‟s hut) 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 year‟s 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 Kisumu‟s 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 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.
Hellen Owuor outside her home
„„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.‟‟
Rianyamwamu peer educators demystifying condom size through
a small-group activity
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 WPI‟s 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.
NOPE‟s 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
higher learning.
National Organization for Peer Educators (NOPE) profile
S Continued on page 3 2
.
The community members supported her and threatened to beat up the
circumciser who upon sensing danger decided to run for her dear life. „„I
want my daughters to be role models and achieve the very best education.”
Says Dorcas with firmness in her voice.
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 NOPE profile
S Strategies and approaches for the WPI are outlined below:
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.
2. Institutional capacity assessments: 20 organizations have been assessed to identify gaps in workplace programming.
3.
Coordination structures: 27 focal persons and coordinators have been trained and 17 steering committees have been established to date. The
trainings increase the member‟s 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
Mother protects her daughters from the “Cut”
Dorcas and her daughters
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, Dorcas‟s 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
husband to their home, she knew without being told what their
intention was.
She shouted, attracting a large crowd of people to their homestead,
and insisted that her daughters would only be circumcised over her
dead body.
APHIAplus Western Kenya 2012 achievements
APHIAplus Western Kenya is a five-year, United States Agency for International
Development (USAID)- funded project to be carried out between January 2011 and
APHIAplus Western Kenya is a five-year, United States Agency for International
Development (USAID)- funded project to be carried out between January 2011 and
.
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.
Reproductive Health
During the year, the proportion of pregnant women making the
required 4 ante-natal clinic (ANC) visits in project supported sites
increased from 42.7% to 56% in Nyanza Province and 34% to 43% in
Western Province. The sites recorded a total of 60,806 skilled
deliveries compared to 37,022 in the previous year. These
achievements could be attributed to a number of interventions
supported by the project,
• Community health education and mobilization for services by
community health workers (CHWs);
• Allowing Traditional Birth Attendants (TBAs) to accompany
mothers from the villages to health facilities for delivery services
• Introduction of motor cycle (boda boda ) ambulances in some
districts for referral of pregnant mothers for delivery in health
facilities.
15,639 women were screened for cancer of cervix in project
supported sites, and those with suggestive lesions provided with
the required management.
Improving Child Health
To promote hand washing among school children, hand washing
facilities were provided to 65 primary schools. During the Global
Hand washing Day celebrations on October 15th , over 13,000 school
children used these facilities.
During the year, at least 250,000 children in early childhood
development centers (ECDs) were dewormed. Through a related
initiative, over 3600 children under 5 years who had defaulted on their
immunization schedules were traced in the last quarter of the year and
immunized.
Reproductive Health
During the year, the proportion of pregnant women making the
required 4 ante-natal clinic (ANC) visits in project supported sites
increased from 42.7% to 56% in Nyanza Province and 34% to 43% in
Western Province. The sites recorded a total of 60,806 skilled
deliveries compared to 37,022 in the previous year. These
achievements could be attributed to a number of interventions
supported by the project,
• Community health education and mobilization for services by
community health workers (CHWs);
• Allowing Traditional Birth Attendants (TBAs) to accompany
mothers from the villages to health facilities for delivery services
• Introduction of motor cycle (boda boda ) ambulances in some
districts for referral of pregnant mothers for delivery in health
facilities.
15,639 women were screened for cancer of cervix in project
supported sites, and those with suggestive lesions provided with
the required management.
Improving Child Health
To promote hand washing among school children, hand washing
facilities were provided to 65 primary schools. During the Global
Hand washing Day celebrations on October 15th , over 13,000 school
children used these facilities.
During the year, at least 250,000 children in early childhood
development centers (ECDs) were dewormed. Through a related
initiative, over 3600 children under 5 years who had defaulted on their
immunization schedules were traced in the last quarter of the year and
immunized.
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 year‟s 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.
4
Comparison of immunization coverage in selected districts in Nyanza and Western provinces, 2012 vs. 2011
Source: District Health Information System 2
VMMC performance trends, Nyanza and Western provinces, Jan–Dec 2012
Source: Minor Theatre Registers, 2012
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.
Clients undergoing HIV testing and counseling at Nyamira District Hospital
`
APHIAplus Western Kenya is a five-year, United States Agency for International
Reproductive Health
During the year, the proportion of pregnant women making the
required 4 ante-natal clinic (ANC) visits in project supported sites
increased from 42.7% to 56% in Nyanza Province and 34% to 43% in
Western Province. The sites recorded a total of 60,806 skilled
deliveries compared to 37,022 in the previous year. These
achievements could be attributed to a number of interventions
supported by the project,
• Community health education and mobilization for services by
community health workers (CHWs);
• Allowing Traditional Birth Attendants (TBAs) to accompany
mothers from the villages to health facilities for delivery services
• Introduction of motor cycle (boda boda ) ambulances in some
districts for referral of pregnant mothers for delivery in health
facilities.
15,639 women were screened for cancer of cervix in project
supported sites, and those with suggestive lesions provided with
the required management.
Improving Child Health
To promote hand washing among school children, hand washing
facilities were provided to 65 primary schools. During the Global
Hand washing Day celebrations on October 15th , over 13,000 school
children used these facilities.
During the year, at least 250,000 children in early childhood
development centers (ECDs) were dewormed. Through a related
initiative, over 3600 children under 5 years who had defaulted on their
immunization schedules were traced in the last quarter of the year and
immunized.
Reproductive Health
During the year, the proportion of pregnant women making the
required 4 ante-natal clinic (ANC) visits in project supported sites
increased from 42.7% to 56% in Nyanza Province and 34% to 43% in
Western Province. The sites recorded a total of 60,806 skilled
deliveries compared to 37,022 in the previous year. These
achievements could be attributed to a number of interventions
supported by the project,
• Community health education and mobilization for services by
community health workers (CHWs);
• Allowing Traditional Birth Attendants (TBAs) to accompany
mothers from the villages to health facilities for delivery services
• Introduction of motor cycle (boda boda ) ambulances in some
districts for referral of pregnant mothers for delivery in health
facilities.
15,639 women were screened for cancer of cervix in project
supported sites, and those with suggestive lesions provided with
the required management.
Improving Child Health
To promote hand washing among school children, hand washing
facilities were provided to 65 primary schools. During the Global
Hand washing Day celebrations on October 15th , over 13,000 school
children used these facilities.
During the year, at least 250,000 children in early childhood
development centers (ECDs) were dewormed. Through a related
initiative, over 3600 children under 5 years who had defaulted on their
immunization schedules were traced in the last quarter of the year and
immunized.
APHIAplus Western Kenya 2012 achievements
Through the PD hearth program, APHIAplus screened 3,976 under-
fives 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.
).
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).
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 small-
scale 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 PATH’s Kenya Country Program, handing over motorbikes to an MOH official in Western Province
5
,
Tomatoes harvested from a greenhouse supported by APHIAplus under Kagwa community-based organization
APHIAplus program officer, Alfred Ochola demonstrating to pupils how to wash hands
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 for 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.
Happiness at last
Janet Ndubi displays bananas she has harvested from her farm
6
Janet, her daughters and grandson outside their home Janet’s banana farm
“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.”
APHIAplus Western Kenya Project is collaborating
with the Ministry of Public Health and Sanitation
(MOPHS) in building the capacity of retired
(domiciliary) midwives to increase deliveries under
skilled attendants in the region. This is in response to the
high number of women delivering at home or under
Pictorials
1
2
3
4
5
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 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
7
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.
Editorial Team Rael Odengo
Mark Okundi
Celestine Asena
Juma Mwatsefu
Dr. Mukabi James
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
Cornelius Kondo
Wamalwa Masibo
Dr. Edward Kariithi
Oby Obyerodhyambo