AIC KIJABE MATERNAL AND NEWBORN COMMUNITY HEALTH PROJECT
ANNUAL REPORT
ANNUAL REPORT 2018 EXECUTIVE SUMMARY: 2018 HIGHLIGHTS MNCH continues to bring health and hope to communities by training community health volunteers attached to government health facilities. We count it a privilege to extend the reach of Kijabe Hospital’s mission and vision to glorify God through provision of compassionate health care, excellent health training and spiritual ministry in Christ Jesus to communities around Kenya.
• We trained CHEWs from 3 Counties on Improving Data Quality for Community Health: demonstrating ways to improve quality health data collection.
• “Unlocking potential: How community health can change the world,” a week long community health training at Garissa University grew more than 70 students and staff in understanding community health.
• Beyond Grading and Compliance; Supervision for Growth and Constructive engagement. This is a Executive Short Course designed to impact front line professionals in health management with the supervision skills required to improve the quality of health care. The module encourages support supervision for all hierarchical levels in the Kenya health tiers. Progress was made on formal accreditation.
• Research: Research from our learning laboratories was presented in multiple forums from County to International level meetings sharing lessons learned to help drive innovation, placing Kijabe Hospital at the forefront of leading change in the health sector.
• County engagement – MNCH worked in Kiambu, Nyandarua, Nakuru, Garissa and this included our first ever basic and maternal health training at Maramtu village, Tana River County. LIST OF ABBREVIATIONS AIC - African Inland Church ANC - Antenatal Care CBO - Community Based Organization CHC - Community Health Committee CHU - Community Health Unit CHV - Community Health Volunteer CHEW - Community Health Extension Worker KH - Kijabe Hospital MNCHP - Maternal Newborn Community Health Project MOH – Ministry of Health NGO - Non Government Organization PHO- Public Health Officer SDG - Sustainable Development Goal TBA - Traditional Birth Attendant
MNCH TEAM Project Director - Dr. Mary Adam (from 1.1.2011) MD, MA, PhD, FAAP. Deputy Director - Dr. Peter Meissner (from 1.1.2011) Project Manager - Joy Njuguna BA Psychology & Counseling Dip. Education. Project Officer - Dr. Maureen McAlhaney OD, MS, MD. Project Officer - Simon Mbugua BSc HSM, KRCHN. Project Research Assistant - Jacob Chege BSc Public Health. Assistant Project Officer - Thomas Renner BA, MA. Assistant Project Officer - Dorothy Renner BS. Project Associate - Geofrey Mwita. Communications and Research Assistant - Wilson Kamiru. Interns – Faith Katheu and Mercy Amojong. ACKNOWLEDGEMENT All thanks and glory to God Almighty for His provision and ministry through MNCH program. We wish to thank the board and the senior management team of AIC Kijabe Hospital; for their continuous support to the MNCH team in the past 10 years in our mission to support the vulnerable communities to improve maternal and newborns health.
We also thank our donors, Stricthing Roer, Netherlands, Dew Foundation, Madison Insurance, Kenya and Equipping Africa, USA for their financial support that has made our activities a success.
We sincerely thank the Navigators, the sending agency of our project director Dr. Mary Adam and SIM the sending agency of Dr. Maureen McAlhaney.
We wish to thank the community leaders and government authorities from the Ministry of Health, Head of the National Community Health Services as well as the County and sub County Health Management Teams for continued support and collaboration. We gratefully acknowledge the Community Health Volunteers who work tirelessly to reach their communities with this project. Lastly, we thank the MNCH staff for their effort in reaching the community with accurate health information and with the love of Jesus Christ despite the challenges they face while on duty. TABLE OF CONTENTS
INTRODUCTION...... 5 OBJECTIVES OF THE PROJECT...... 6 NEW COMMUNITY HEALTH UNITS...... 7 SALT...... 8 IMPROVING DATA QUALITY FOR COMMUNITY HEALTH...... 9 RESEARCH ...... 9 PICTORIAL...... 10 GARISSA TRAINING ...... 12
TANA RIVER TRAINING...... 12
INNOVATE FOR HEALTH...... 13 MOBILE MONEY PAYMENT...... 13 APPENDIX...... 14 INTRODUCTION
For 10 years AIC Kijabe Maternal and Newborn Community Health Project (MNCH) has provided excellent health training, compassionate care and spiritual ministry in Christ . Our goal is to grow healthy communities in line with the Sustainable Development Goals with a focus on SDG #3: To ensure healthy lives and promote well-being at all ages. We have unique expertise in programs that address neonatal and maternal health to reduce morbidity and mortality (SDG 3.1, 3.2 and 3.7), achieve universal access to care (SDG 3.8),develop and train the health care workforce at level 1 and 2 of Kenya’s health tiers. OBJECTIVES OF THE PROJECT
1. To partner with MOH at county and sub county levels in establishing Community Health Units (CHUs), strengthening the existing CHUs, in-service training and technical support for CHEWs working at Tier 1 & 2.
2. To improve health promotion and disease prevention with a focus on Maternal and Newborn health module using a government certified curriculum which includes; importance of ANC, developing an individual birth plan, danger signs in pregnancy, how to care for newborns , danger signs in newborns, importance of exclusive breast feeding, expanded program on immunizations, danger signs in a postnatal mother and the role of men in improving maternal and child health.
3. Training CHVs and CHEWs to collect and utilize accurate household level data using government certified tools (MOH 513, 514) to develop and improve community health information systems.
4. To develop community based participatory processes through operational research to build capacity in primary healthcare systems, support the communities to identify and utilize their strengths to drive local solutions (SALT).
5. To develop quality improvement processes and tools; starting at Level 1 and that work across the continuum of care (spanning the community, facility healthcare, and mid-level management) strengthening the health care system in Kenya.
6. Spiritual growth that demonstrates its reality by bringing health and hope to communities. MNCH reached its 10 years mark in July 2018. Through the decade the project has trained and built Community Health capacity in 14 counties around Kenya as far as Garissa and Tana River. MNCH uses a mentor style approach to promote longterm sustainability
These are MNCH achievements through out 2018:
New Community Health Units In 2018 the project established 6 CHUs namely; Githabai in Kinangop sub county, Githirioni, Gituamba, Kagwe and Karatina in Lari sub county, Maramtu in Madogo ward, Tana river county. Selection of units is directed by the local MOH so we focus on high need areas. These new units were trained for 5 days using the community health volunteer basic health manual. Each group then gets a day’s training each month for the next 6 months on maternal and newborn health.
All CHUs established in 2018 graduated and received certificates; a certificate for basic health and another for maternal and newborn health modules. 4 community units that began the training after mid-year 2017 also graduated in 2018 with similar credentials. They are Munyu and Nkaampani units in Naivasha sub county, Bathi and Gitithia in Lari sub county.
Group discussions and presentation is encouraged during trainings for inclusive participation
7 2. SALT - (Strengthen-Appreciate-Learn-Transform)
SALT begun is 2016. The 3 days workshop stimulates volunteers to solve their own issues using locally available resources. MNCH realized that the units established are constantly dependent on external help to develop and hold together thus SALT to help them remain active and sustain themselves. During the workshop, CHVs develop action plans through group interaction looking at their community’s prioritized challenges when addressed add value to the primary healthcare systems and improve their livelihoods.
Year 2018, SALT commenced in February at Karagita, Naivasha sub county. MNCH trained 30 CHVs from Miti mingi, Rubiri, Sanctuary and Karagita villages of Naivasha sub county. In the month of April, 30 CHVs from Kamirithu unit and Kamandura unit in Limuru sub county participated in a SALT workshop. 30 CHVs from Nderu and Ndiuni community of Ndeiya CHU in Limuru sub county underwent SALT training in the month of July 2018. In the same month SALT training manual was published. Among these groups, MNCH saw community challenges like nutrition, sanitation and drug abuse being tackled by CHVs and economic start ups in form of kitchen gardens, poultry rearing and table banking being born. Follow ups for all SALT groups is on-going.
Kamirithu CHVs exhibiting one of the many kitchen gardens they established in 2018.
8 Improving Data Quality for Community Health Decisions
MNCH conducted a 3 days MOH data collection training for CHEWs from Lari, Limuru, Naivasha, Kinangop, Ol kalau and Kipipiri sub counties. The training emphasized on handling areas that are a challenge in filling the data collection tools. This was necessitated by the identified gap where CHVs had little knowledge in filling the reporting tool (MOH 513 & MOH 514) and inadequate utilization of the data collected.
Joy of MNCH facilitating the Improving Data Quality for Community Health Course at AIC Kijabe Hospital
Research Dr. Maureen McAlhaney presented a case study on women delivery decisions in Naivasha Sub County to Nakuru County Health Management Team in March 2018. This data dissemination conference was part of Nakuru county health continuing professional development engagement. Jacob and Joy of MNCH presented two research topics at the 1st Machakos University international conference; “MamaTips: a social enterprise that provides better maternal health services through mobile messages automated system and “Utilizing new technological applications for improved community health program efficiency and effectiveness” respectively. Dr. Mary Adam presented a research on “Trust in health systems” at Aga Khan University Hospital, Nairobi and in Liverpool, United Kingdom.
9 PICTORIAL
Serah presents an action plan to fellow CHVs addressing a need in the community at Kamirithu SALT workshop.
Director General AIC Kijabe Hospital Dr. Ken Muma (in white coat) Members of Nakuru county health management teams discussing along side MNCH director Dr. Mary Adam, Simon Mbugua and KH Naivasha women deliery decisions data with Dr. Peris Kariuki (in Finance director Mr. Sam Mwaura receive a check from Madison red) the principal AIC Kijabe College of Health Sciences. Insurance officials.
Nkaampani - Maiella CHVs demostrate to villagers and fellow volunteers how to make and use a tippy tap; a hand washing equipment. CHVs demostrating proper breastfeeding. Simon of MNCH presents Moses Mwangi of Githabai CHU with certificates of completion after 7 months of Basic and Maternal health training
Nkaampani CHVs graduation group photo with Dr. Njuguna, Naivasha sub county head of health.
Thika sub county health management CHEWs discussing a data collection tool during the team with MNCH staff after the Beyond Improving Data Quality For Community Health Course grading and compliance course follow up. GARISSA COUNTY Unlocking potential: How community Health changes our world. In the months of January and September 2018 MNCH was in Garissa University for the bi- annual one week training on “Unlocking potential: How community health changes our world.” This year we trained 72 students and 7 university staff. The trainees develop action plans that they showcase a month after the training on an action day at Garissa University trainees demostrating first aid skills the university.
Thomas Renner of MNCH facilitating a lesson at the Garissa University training.
TANA RIVER COUNTY In October 2018 MNCH trained 34 CHVs in Maramtu, Madogo ward, Tana River County on basic health. Pre and postnatal care is a recurrent challenge in this comm- unity and for the next 7 months the volunteers will received maternal health education for a day each month. Maramtu CHVs discussing opportunities in their community to improve health. 12 Innovate for Health In a bid to support the new dawn at AIC Kijabe hospital, MNCH initiated the Innovate for Health Competition, 22 May - 20 July 2018. MNCH continues to work to incubate ideas that create durable working solutions in line with the hospital’s strategic plan of 2018 - 2022: Laying the ground work for growth and sustainability.
Mobile Money Payment MNCH has moved to mobile money transfer in carrying out training and workshop reimbursements, purchases and service payments. This payment system has eased the project’s monthly financial reconciliation procedure.
13 Appendix Community Health Units trained in 2018
Name of CHU County/Sub county Year No. of CHVs trained Githirioni Kiambu / Lari 2018 15 Gituamba Kiambu / Lari 2018 15 Githabai Nyandarua / Kinangop 2018 30 Nkaampani Nakuru / Naivasha 2017-18 24 Maiella Nakuru / Naivasha 2018 17 Bathi (MN) Kiambu / Lari 2018 15 Gitithia (MN) Kiambu / Lari 2018 15 Munyu (MN ) Nakuru / Naivasha 2018 26 Kamae (MN ) Kiambu / Lari 2018 24 Karagita* Nakuru / Naivasha 2018 30 Ndeiya* Kiambu / Limuru 2018 30 Kamirithu* Kiambu / Limuru 2018 30 Maramtu Tana river / Madogo 2018 34 Garissa univ ersity Garissa 2018 79
MN - Maternal and Newborn Health training only * SALT workshops
CHEW Training Course outline: https://docs.google.com/document/d/1fxD7Hdb7o1wbhxXPoLwAhJJetk_ TX3gWLRwLZNcA3Ek/edit?usp=sharing
Budget data is available on request.
14 Relevant Presentations/ Publications Meissner P, Dillmann M, Mbugua S, Ndung’u J, Mumbi P, Waweru E, Chen M, Adam M. Auswirkungen eines Dorfgesundheitsprojektes in Kenia zur Unterrichtung von Frauen über geburtshilfliche Themen (Effects of a community health project to inform women about obstretic issues.), 31st Annual Conference of the German Society of Tropical Pediatrics 25.-27 January 2013, Tübingen, Germany
Adam M, Chen M, Dillmann M, Waweru E, Mbugua S, Ndung’u J, Mumbi P, Meissner P. The relative influence of important contextual factors on women’s intentions to deliver at a facility with a skilled delivery attendant among rural small scale farming communities in Central Province Kenya. 10th Annual Global Health and Innovation Conference, April 12-13, 2013. Yale University, New Haven, Connecticut
Murage B, Dillmann M, Waweru E, Mbugua S, Ndung’u J, Mumbi P, Meissner P, Adam M. Research training methods for obtaining high quality data usingsubsistence farmers as interviewers in a Maternal and childhealth study in rural Kenya. 14th Annual Scientific Congress of the Kenya Pediatric Association, April 17-20, 2013, Mombassa, Kenya.
Ndung’u J, Mbugua S, Waithera C, Anene-Muli R, McAlhaney M, Adam M. The impact of in- service training for community health extension workers in Kenya. 11th Annual Scientific Conference of the Tropical Institute for Community Health, April 30-May 2, 2014, Kisumu, Kenya.
Anene-Muli R, Mbugua S, Waithera C, Ndung’u J, Adam M. Innovations in human resourced for health: Development of a CHEW in-service course from the Kijabe Community Health Training Center. 11th Annual Scientific Conference of the Tropical Institute for Community Health, April 30-May 2, 2014, Kisumu, Kenya.
Waithera C, Anene-Muli R, Ndung’u J, Mbugua S, Adam M. Cost benefit analysis of development of a community health unit in a naïve area. A case study of Kinale Sub location Utugi community Unit. 11th Annual Scientific
15 Conference of the Tropical Institute for Community Health, April 30-May 2, 2014, Kisumu, Kenya.
Onguka, S., Korom, R., Halestrap, P., McAlhaney, M.S., & Adam, M.B. (2015, March). Applying Classical Learning Theories to Quality Improvement Interventions Among Mid-Level Providers in Kenya. Poster presented at the meeting of Consortium of Universities for Global Health, Boston, MA.
Korom, R.,Onguka, S., Halestrap, P., McAlhaney, M.S., & Adam, M.B. (2015, March). Applying Prescription for success: Changing prescribing behavior in a developing country context. Poster presented at the meeting of Consortium of Universities for Global Health, Boston, MA
McAlhaney, M.S.; Mbugua S, Ndung’u J, Waithera, C., Jowi, B.S, Adam, M.B. Effects of a short training course and professional background on the job performance of community health extension workers in Kenya. Poster presented at the meeting of Consortium of Universities for Global Health, April 10, 2016, San Francisco, CA.
Adam MB, Donelson A, Mbugua S, Ndungu J, Waithera C, Chege J. Human Centered Design for rapid results: improving quality in close to the community health systems in four Kenyan Villages. Presented at the 1stInternational Symposium on Community Health Workers, Kampala, Uganda, Feb 22-24, 2017.
McAlhaney, M.S., Adam, M.B. Understanding delivery decisions of Naivasha Subcounty Mothers. Presentation to the Nakuru County Health System Management Team, Nakuru, Nakuru, March 5, 2018.
Minyenya, J, Mathuku, J, Kamiru, W, Mbugua, S, Gichimu, J, Adam MB. Secrets to success in informal sector compliance financial compliance: Utilizing new technological applications for improved community health program efficiency and effectiveness. Presented at the 1st Annual International Conference: Harnessing Scientific Research Innovation and Technology for Sustainable Development. Machakos University, Machakos, Kenya, April 16, 2018. 16 Gichimu, J, Nyatigo, F, Adam MB. A social enterprise, better maternal health services through mobile messages automated system, a pilot study in AIC Kijabe Hospital in Kiambu county. Presented at the 1st Annual International Conference: Harnessing Scientific Research Innovation and Technology for Sustainable Development. Machakos University, Machakos, Kenya, April 16, 2018. Adam, MB, & Donelson AJ. Trust is the engine of change: A conceptual model for trust building in health systems. 5th Global symposium on Health Systems Research, Liverpool England, Oct 10-12, 2018.
Publications Adam, MB, Dillmann M, Chen MK, Mbugua S, Ndung’u J, Mumbi P, Waweru E, Meissner P. Improving Maternal and Newborn Health: Effectiveness of a Community Health Worker project in Rural Kenya. PLoS ONE 9: e104027. 2014.
Adam MB, Donelson A, Mbugua S, Ndungu J, Waithera C, Chege J. Human Centered Design for rapid results: improving quality in close to the community health systems in four Kenyan Villages. BMC Proceedings, 2017, 11 (Supp 6): 10. doi:10.1186/s12919-017-0074-9. https://bmcproc.biomedcentral.com/track/pdf/10.1186/s12919-017- 0074-9?site=bmcproc.biomedcentral.com.
Adam MB, Donelson AJ, eds. Strengthen, Appreciate, Learn and Transform (SALT) Training Curriculum: Driving Change in Close to Community Health Systems. Kijabe, Kenya. AIC Kijabe Maternal Newborn Community Health, 2018.
Adam MB, Muma S, Modi JA, Steere M, Cook N, Ellis W, Chen CT, Shirk A, Muma Nyagetuba JK, Hansen EK. Pediatric and Obstetric outcomes for a faith-based hospital during Kenya’s 100-day public sector physicians strike. BMJ Global Health 2018;3:e000665.