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Ochieng' Memorial Lwala Community Health Center

1. Summary
On April 2nd 2007, after over 2 years of fundraising and construction, the Ochieng'' Memorial Lwala Community Health Center opened its doors. Since that day it has seen over 1,500 patients per month, mostly women and children. At present the health center provides basic primary care and maternal and child health services. It provides these services free of charge to approximately 85% of patients. The tremendous turnout is evidence of the great need for affordable quality health care in Lwala. Though we offer basic primary care at present, our patients have advocated and occasionally demanded the provision of more comprehensive services, particularly in the area of maternal and child health. The aim of the health center is not to become a tertiary care facility, but to develop excellent community-based health care services, including maternity and HIV/AIDS programs. Whenever possible, these programs will be designed to address problems at their roots through public health intervention, development and education.

The Ochieng' Memorial Lwala Community health center fills a gap in the Kenyan health system. The Kenyan Ministry of Health struggles to extend services to rural areas, and its services do not reach Lwala. This is a problem across Africa, and is at the core of the challenges in scaling up antiretroviral therapy for HIV/AIDS. Lwala represents a unique response to this problem, the empowerment of village social infrastructure to build health infrastructure. With this hope in mind, we work in close partnership with the Kenyan Ministry of Health to integrate and coordinate its top-down model with our bottom-up approach.

2. Services

2.1. General Outpatient Care
The health center provides basic outpatient services five days a week. These include consultation, laboratory examination and medication. The most commonly treated diseases are malaria, diarrhea, respiratory infections and diseases of the skin. Sixty percent of the clinic's patients are children under five years old. Of the other forty percent, the majority are antenatal mothers and elderly people. The health center has a small ward where it provides IV fluids and medications and monitors very ill patients. Typically these patients are monitored during the day then released, but patients more seriously ill are monitored overnight.

2.2. Maternal and Child Health Program, Vaccination, and PMTCT

Though children and antenatal mothers are seen throughout the week and make up the bulk of the patient population, the health center provides specialized maternal and child health care two days a week. This includes vaccinations, family planning, and prenatal care including prevention of mother to child transmission (PMTCT) of HIV.

2.3. Malaria Prevention
The health center distributes bed nets to antenatal mothers and mothers of small children.

3. Patient Fees

As determined by the Lwala Village Development Committee, the maximum fee at the Lwala Health Center is 50 Kenyan Shillings, approximately $0.75 US, which includes all services from consultation to laboratory examination to treatment. However, children under 5, antenatal mothers, patients aged 70 and older, and patients with Tuberculosis or HIV/AIDS are seen free of charge. Additionally, patients unable to pay after consultation with the secretary and manager are not charged. Approximately 85% of patients are seen free of charge.

4. Patient Population and Load

Since it opened in April 2007, the health center has seen over 1,500 patients per month. Most patients come from the nearby villages, but some walk as far as a day's walk for treatment. Sixty percent of patients are children under five. Based on data from the surrounding area and on a testing campaign undertaken in Lwala in August 2006, approximately thirty percent of the general population in Lwala may be HIV positive. In a self-selected sample of over five hundred adults from Lwala, forty percent of women and twenty four percent of men tested positive. It is likely that an even higher percentage of patients at the health center are HIV positive.

5. Staff

The health center employs a manager, a registered clinical officer, three registered nurses, a registered laboratory technologist, a pharmacist, a nurse aid, a secretary, two night guards, a groundskeeper and a housekeeper. The manager is responsible for daily operations of the health center, staff management, and financial reporting. The clinical officer, the Kenyan equivalent of a Physician's assistant, is the medical officer in charge and is responsible for clinical and public health services. One nurse specializes in maternal and child health and another in community health. The lab technologist is responsible for all lab services and maintenance and equipping of the laboratory. The pharmacist is responsible for dispensing drugs and managing the pharmacy stock. The secretary is responsible for registering patients and maintaining the clinical records system. The secretary also assists the manager in financial recordkeeping. All staff members are salaried employees with contracts regarding their responsibilities and benefits at the health center.

6. Health System Networking and Referral System

6.1. Regional Health System Context Lwala is in the newly-formed Rongo district in Nyanza Province, Kenya. The district medical facility was upgraded in mid-2007 from a health center to a hospital, and now provides HIV and TB care. It has a small ward but does not provide surgical services. This facility is approximately 12km from Lwala, but due to poor roads, lack of funds for transport, and moderate but still unaffordable patient fees, many people in Lwala cannot access it. There is a larger mission hospital called the St. Camillus Tabaka Mission Hospital approximately 20km from Lwala. This is a tertiary care hospital providing quality service, but it charges fees prohibitive for almost all people in Lwala. Approximately 35km from Lwala the town of Kisii has several hospitals, though they are of low quality.

In spite of relatively small distances to other facilities, the challenges of transport over poor or no roads and financial poverty make these facilities inaccessible to most people in Lwala.

6.2. Ministry of Health Partnership

The Lwala Health Center has forged a collaborative relationship with the Rongo District Ministry of Health (MOH). The MOH provides various medications, vaccines and supplies to the health center. It also provides training for clinic staff. The district MOH team occasionally visits the Lwala Health Center to provide in-situ mentorship and training for staff. The Lwala Health Center complies with MOH reporting requests for certain infectious diseases.

6.3. Referral Agreements
The Lwala Health Center refers some cases to the District Hospital in Rongo when judged appropriate by the clinical officer. More complicated or emergent cases are referred to the St. Camillus Tabaka Mission Hospital. The Lwala Health Center and the Tabaka Mission Hospital have a memorandum of understanding regarding how these cases are admitted, paid and followed-up. Both the District Hospital and the Tabaka Mission Hospital have ambulances which can be called by the Lwala Health Center, but they are not capable of reaching Lwala during rainy weather due to the poor road. The Lwala Health Center also refers patients suspected of being HIV positive to the Tabaka Mission Hospital for testing and antiretroviral therapy.

7. Financial Operations and Reporting
Accurate and detailed reports are the responsibility of the manager and the executive committee of the Lwala Village Development Committee. Records are kept on paper, certified monthly by several members of the clinic staff and the Lwala Village Development Committee, and sent to the U.S. along with copies of original documentation, where they are computerized. This system of records was adapted from an organization that partners with indigenous organizations to help them meet USAID reporting standards.

8. Community Ownership and Input

The health center was founded and built by the Lwala Village Development Committee (LVDC). This committee continues to play an integral role in managing the clinic and liasing with the community to ensure a sense of community ownership and volunteerism. The LVDC includes two representatives of each clan in the village. This committee meets approximately every two months and acts in an advisory capacity with regard to community and cultural relations. An executive committee of the LVDC is integrally involved in the day-to-day management of the clinic, and holds shared responsibility with the executive director of the Lwala Community Alliance for overseeing the health center manager. The manager and the secretary of the health center sit on the LVDC executive committee to ensure tight coordination between these two bodies. Both of these committees are structured to take advantage of indigenous accountability structures that work in concert with stringent financial reporting standards to ensure proper stewardship of funds.

The documentary "Sons of Lwala" follows our founders, Milton and Fred Ochieng" on their journey from their home village of Lwala, Kenya to medical school in the United States, and back home to build Lwala's first health clinic.
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