APPROACH
LCA is committing to 'Thrive thru 5,' an all-out effort to reduce under-five mortality by 50% in the Lwala Community Hospital catchment area by the end of 2016. Specifically, 'Thrive thru 5' will ensure that: 1) 98% of all pregnant women in the catchment area access prenatal care and deliver in a health facility; 2) 90% of children under 12 months are fully immunized; 3) 7,000 children under five have access to affordable primary care; and 4) 2,400 women and adolescent girls have access to contraceptive options.
To accomplish these objectives, LCA will employ a community-facility approach. Frontline health workers will map, recruit, and track a cohort of 3,000 families with children under five in the hospital catchment area. The Lwala Community Hospital will serve as the primary care point and the coordination center for collaboration with local Ministry of Health facilities. As a grassroots health care provider, LCA has built strong community trust bonds through conducting ongoing outreach to local households and has a proven track record of utilizing a community-facility strategy to bring healthcare to this rural population.
Furthermore, LCA is positioned to transfer knowledge and best practices to peers working in rural sites around the globe. By documenting evidence, results, and processes and purposefully sharing these lessons, the 'Thrive thru 5' commitment will contribute to the global effort to reduce under-five mortality and advance priorities such as the Millennium Development Goals and the WHO's Newborn Action Plan.
LCA's various partners will contribute financial and technical support to enact 'Thrive thru 5' outreach, expand the Lwala Community Hospital, and provide additional staff housing in order to meet the rising demand for pediatric health services and protect children from the most common causes of under-five mortality (malaria, HIV, severe diarrhea, pneumonia, measles, injuries, and malnutrition (World Health Organization, 2011).
ACTION PLAN
January - June 2014:
1) Secure funding from Segal Family Foundation, Ronald McDonald House Charities, Blood:Water Mission, Watsi, Real Medicine Foundation, Planned Parenthood Global, and Izumi Foundation and Health eVillages for hospital expansion, as well as outreach for new partnerships.
2) Clinical services expand to provide prenatal and pediatric care, involving community outreach and the training of community health workers (CHW) in Integrated Management of Childhood Illness (IMCI), and begin deworming and vitamin provision in local schools.
3) Knowledge sharing, including data collection tools of 'Thrive thru 5,' and share progress and best practices at Global Health and innovation Conference in April, as well as finalize designs for hospital expansion and staff housing.
July - December 2014:
1) Announce 'Thrive thru 5' at 2014 CGI Annual Meeting, and continue with clinical services, community outreach and data tracking, and hospital expansion; knowledge sharing from document training modules, data collection and academic dissemination of findings with Harper Collins Publishing, and at Annual WASH Sports Tournament to 5,000 community members and Segal Family Foundation Annual Meeting in July.
January - June 2015:
1) Begin 2015 yearlong partnership/funding development, and continue prenatal/pediatric health training and community outreach. Tracking system implemented through electronic medical record (EMR) system.
2) Academic reporting and data sharing with report to Global Health and Innovation Conference (Yale); support from Vanderbilt research faculty regarding the creation of manuscripts for scientific journals.
July - December 2015:
1) Focus on WASH trainings in community, sexual and reproductive health, and prenatal/pediatric clinical health services.
3) Submit academic manuscripts, and continue with completed hospital infrastructure expansion.
January - June 2016:
1) 2016 partnership development kickoff, and continued pre & post natal/pediatric services with focus on hospital utilization
2) Refresher trainings for CHW and recruiting of CHW, migration to EMR system.
July - December 2016:
1) Publicize results of program and engage constituencies at Annual WASH Sports Tournament and Segal Family Foundation Annual Meeting, as well as additional presentation opportunities in 2017.
Lwala Community Alliance (LCA) is a Kenyan health and development agency serving 20,000 people in the rural northwest corner of Migori County near Lake Victoria. This county has acute development needs: HIV rates are triple the national average while infant and maternal mortality rates are twice the national average. Migori County's under-five mortality rate is a startling 150 out of 1,000, 20 times higher than in the U.S.'s under-five mortality rate (Kenya Demographic and Health Survey, 2010).
Central to LCA's work is the Lwala Community Hospital, which serves 3,800 households in a 75 square mile catchment area by providing primary care; maternal, neonatal, and child health services; family planning; and HIV treatment. With a team of nearly 200 Kenyans and a presence on the ground since 2005, LCA focuses on community-based change and aims to foster transferability of its practices to similar rural settings.
Through the successful completion of LCA's previous CGI commitment (Safe Motherhood in Lwala, Kenya), early infant mortality (babies who die within the first month) in LCA's catchment area has been reduced to 31 out of 1,000 (compared to 60 out of 1,000 in Migori County as a whole). The most notable driver in LCA's success is the rate of facility-based delivery, which has risen from 26% of pregnant women, in 2010, to 96%, in 2013. To achieve this, LCA expanded the health facility and deployed community health workers to map and track 100% of pregnant women in the catchment area with the intent to ensure access to prenatal care, facility-based delivery, newborn care, and infant immunizations.
However, extending care past infancy is essential in sub-Saharan Africa, which accounts for half of the world's under-five mortality (UN, 2012). Building on its prior success in maternal and child health programming, LCA will provide extended pediatric health services targeting children under five.
April 2016
In order to complete its commitment to 'Thrive thru 5', LCA is seeking best practice information on reducing under-5 mortality, implementing partners, marketing opportunities, and media support.
April 2016
LCA will provide commitment partners with best practice information. The 'Thrive thru 5' outreach model is an ideal innovation to transfer to other rural settings because it (1) addresses an important public problem (under-5 mortality), (2) will have data to prove its results, and (3) is implemented by a local civil society organization in a closed ecosystem, making attribution easier to determine. LCA documents evidence, results, and processes and purposefully shares these lessons with peer organizations to foster transferability to similar settings. In addition, LCA will utilize earned PR through its public platforms (online media, speaking engagements and conferences, partner networks, and publishing).
