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