G-1243

Kenya Maternal Health with MM

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Project Description

Region: Africa

Country: Kenya

Location: Mfangano Island

Total Budget: $35,300

Area of Focus: Maternal and child health



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With support of a $35,200 Rotary Global Grant, this project aims to expand the proven Mfangano Health Network and build Micro Healthcare Support Teams to coordinate a maternal and reproductive health campaign with this at-risk community of 26,000 people in rural Western Kenya.

The Issue: Mfangano Island, Kenya

The remote communities of Mfangano Island, Lake Victoria, Kenya, home to 26,000 Suba and Luo people, represent one of the poorest and most HIV prevalent populations in East Africa, and demonstrate some of the highest fertility rates in the region. With local HIV prevalence on Mfangano Island estimated at approximately 30% for over a decade, few places in the world have been hit harder by HIV/AIDS. , Homa Bay County, where Mfangano Island is situated, is among 15 counties with the greatest maternal and newborn mortality burden in Kenya. Skilled birth attendants attend only 36.8% of births that occur in rural areas. Separated from definitive healthcare on the mainland by a 2-hour boat ride, quality health care services are difficult to access.

Research on Mfangano has shown that instead of relying on challenging to reach health facilities, individuals rely heavily on social networks (eg. extended families, friends, church groups, farming cooperatives, women's groups, school clubs, etc.) for health maintenance. Yet, without efforts to formally involve these same social networks in the life-long health maintenance of HIV treatment or maternal health, individuals in many communities remain stigmatized and isolated and are forced to navigate challenging healthcare decisions on their own.

To address these health challenges, the Rotary Club of Mbita Mfangano is partnering with the supporting partner, Organic Health Response (OHR)-Ekialo Kiona Center, to enroll all interested residents into Micro Healthcare Support Teams and implement a novel maternal and reproductive health education campaign on Mfangano Island.

Project outcomes:

This Rotary project intends to support the building of a unique and powerful health maintenance network for this island community, with the following outcomes:

 Improve rates of HIV testing, enrollment and engagement in HIV clinical care, specifically for women and adolescent girls of childbearing-age

 Increase HIV knowledge, reduce stigma and improve social network support

 Empower mothers and adolescent girls with knowledge and access to quality health services to improve maternal and reproductive health

 Reduce rates of early marriages, pregnancies, and school drop-outs

 Improve knowledge of personal health, reproductive health and of HIV status

 Increase number of women seeking antenatal care during pregnancy

 Increase number of women delivering with a skilled birth attendant.

The Issue: Mfangano Island, Kenya

The remote communities of Mfangano Island, Lake Victoria, Kenya, home to 26,000 Suba and Luo people, represent one of the poorest and most HIV prevalent populations in East Africa, and demonstrate some of the highest fertility rates in the region. With local HIV prevalence on Mfangano Island estimated at approximately 30% for over a decade, few places in the world have been hit harder by HIV/AIDS. , Homa Bay County, where Mfangano Island is situated, is among 15 counties with the greatest maternal and newborn mortality burden in Kenya. Skilled birth attendants attend only 36.8% of births that occur in rural areas. Separated from definitive healthcare on the mainland by a 2-hour boat ride, quality health care services are difficult to access.

Research on Mfangano has shown that instead of relying on challenging to reach health facilities, individuals rely heavily on social networks (eg. extended families, friends, church groups, farming cooperatives, women's groups, school clubs, etc.) for health maintenance. Yet, without efforts to formally involve these same social networks in the life-long health maintenance of HIV treatment or maternal health, individuals in many communities remain stigmatized and isolated and are forced to navigate challenging healthcare decisions on their own.

To address these health challenges, the Rotary Club of Mbita Mfangano is partnering with the supporting partner, Organic Health Response (OHR)-Ekialo Kiona Center, to enroll all interested residents into Micro Healthcare Support Teams and implement a novel maternal and reproductive health education campaign on Mfangano Island.

Project outcomes:

This Rotary project intends to support the building of a unique and powerful health maintenance network for this island community, with the following outcomes:

 Improve rates of HIV testing, enrollment and engagement in HIV clinical care, specifically for women and adolescent girls of childbearing-age

 Increase HIV knowledge, reduce stigma and improve social network support

 Empower mothers and adolescent girls with knowledge and access to quality health services to improve maternal and reproductive health

 Reduce rates of early marriages, pregnancies, and school drop-outs

 Improve knowledge of personal health, reproductive health and of HIV status

 Increase number of women seeking antenatal care during pregnancy

 Increase number of women delivering with a skilled birth attendant.

Proof the program works:

OHR successfully completed the pilot phase of this program in 2012, training and graduating 46 Micro Healthcare Support Teams in the Mfangano East sub-location, involving over 529 community members. All teams completed an innovative 6-month, 12-session curriculum to explore HIV/AIDS biology, group communication skills, and community mobilization to support families affected by HIV. Using a "train-the-trainer" model, the curriculum was facilitated by 28 Community Health Workers from Mfangano East to educate their teams in small groups. Upon completion of the curriculum, greater than 90% of program participants participated in formal group HIV counseling and testing sessions, allowing over 100 HIV-positive participants to disclose their HIV status for the first time to family and friends. To our knowledge, this is the first program in East Africa to facilitate successful community-wide disclosure on this scale!

Through cutting-edge research with world leading researchers at the University of California-San Francisco and the Kenya Medical Research Institute, Organic Health Response recently published its results in leading journals demonstrating statistically significant improvements in retention in HIV care, as well as improved medication adherence among participating communities. Additional qualitative research has demonstrated important community-wide reductions in stigma, improved social support, and collective responsibility for HIV care. The community-research department at OHR continues to explore the roots of disease and poverty along the shores of Lake Victoria, and is building evidence for effective interventions in partnership with local organizations such as Rotary Club of Mbita Mfangano and the Kenya Ministry of Health.

Project plan:

Using the proven Health Network model, the Rotary Clubs of Mbita Mfangano and Ft. Collins Breakfast, in partnership with the Organic Health Response, will develop and finalize the Mfangano Health Network delivery platform for critical education and outreach services in the community. Today, 114 Micro Healthcare Support Teams trained on HIV exist on Mfangano. This project will create 70 new teams to provide access to 15 new villages. Using the fully expanded network, this project will deliver a comprehensive public health campaign focused on maternal and reproductive health. With very basic health services on the island, this project will also develop a referral system to link team members to a higher level of care on the mainland.

The 12-month project aims to:

1. Expand the Mfangano Health Network by creating 70 new Micro Healthcare Support Teams to provide access for 15 new villages on Mfangano Island and expand the scope of all 184 teams to cover maternal health issues.

2. Develop and implement a community-level, maternal and reproductive health campaign focused on antenatal care, safe delivery, and family planning/reproductive health for all teams within the Mfangano Health Network.

3. Activate a comprehensive outreach, referral and monitoring service across villages in all 4 sub-locations of Mfangano Island, Kenya.

The Mfangano Health Network educates teams on HIV, maternal and reproductive health and connects them to their nearest health center. For higher level care, including cesarean section for laboring mothers, team members are linked directly to the closest hospital on Kenya's mainland.

Project activities:

1. Recruit, register, and train 70 new Micro Healthcare Support Teams in Mfangano North, West and South sub-locations.

2. Recruit and train 40 community health workers to organize and facilitate curriculum classes and outreach services.

3. Deliver culturally relevant HIV curriculum for rural communities along the shores of Lake Victoria, for use during this project and for dissemination among local, regional and international partners.

4. Coordinate 12 maternal and reproductive health outreach campaigns across the entire network, to provide education on pregnancy, antenatal care, male support in pregnancy, birth planning, mother-to-child-transmission (MTCT), obstetric emergencies and transportation, and postpartum follow-up. Outreaches will provide "youth-friendly" testing, counseling and referrals for HIV, sexually transmitted infections, pregnancy, and rape, as well as first aid services.

5. Coordinate care and conduct follow-up for 1,000 pregnant women, before and after birth, as well as with any participant in need of referral services.

6. Conduct 4 specialty trainings for community health workers on antenatal care, birth planning, obstetric emergencies/transport and follow-up.

Monitoring and Evaluation of Project:

Working in close partnership with Organic Health Response-Ekialo Kiona Center and the Ministry of Health Kenya (MOH), RC Mbita Mfangano will collect data on pertinent indicators to assess the progress and impact of this project on maternal health and HIV outcomes in the community. Data will be collected using MoH log books on antenatal care and deliveries as well as Mfangano Health Network monitoring and evaluation system, which currently tracks information on the number of Micro Healthcare Support Team participants, sessions attended, participants disclosed, referrals, outcomes and follow-ups.

Indicators that will be tracked and reported include the number of participants that completed the new curriculum session, number of referrals made, number of consultations with an HIV counselor, rate of HIV testing, rate of HIV status disclosed to team members, number of women seeking antental care, number of women delivering with a skilled birth attendant, and rates of early marriages, pregnancies and school drop-outs. .

This data will be reviewed by RC Mbita Mfangano every two months to make ongoing improvements, as well as at the end of the project, to share results, impact and lessons learned with the wider Rotary network. In addition, RC Mbita Mfangano will work in conjunction with the Ministry of Health and Organic Health Response to track and monitor data for five years from the start of this project. This type of monitoring and evaluation will allow RC Mbita Mfangano to record project impact and share results and findings with the greater community for improved project development.

Project timeline and phases:

December 2016: Planning

January - March 2017: Registration and Preparation

Register 70 new Micro Healthcare Support Teams on Mfangano Island (~500 participants)

Train 40 Community Health Workers as facilitators

Purchase outreach equipment

April - June 2017: Training

Conduct 8-session curriculum for teams over 3-months

Graduate teams and provide branded T-shirts upon completion of training to create team solidarity

April - December 2017: Outreach & Care Coordination Campaigns

Complete 12 outreach campaigns focused on maternal and reproductive health

Coordinate care, provide referrals and follow-up for 1,000 pregnant women and adolescent girls, as well as any other community member in need of emergency response

January - December 2017: Specialty Training for CHWs

Conduct 4 specialty trainings for community health workers on antenatal care, birth planning, obstetric emergencies and transportation, and follow-up.

2. Describe how the project will benefit the community and/or improve the lives of the less fortunate.

The inhabitants of Mfangano Island are some of the poorest and most affected by HIV populations in East Africa and the world. Today, Micro Healthcare Support Teams on Mfangano have the potential to address an array of community health needs in addition to HIV, from access to family planning, birth planning and emergency transport, to child nutrition, with proven results. Through this process, we have found that strengthening relationships at the micro-level can improve macro-level change. This program will build the capacity of local leaders, healthcare workers, and parents to improve healthcare for their families and communities. Moreover, this program will strengthen relationships between patients and healthcare facilities, improving access and advocacy for maternal and reproductive health in the region.

Maternal health training, education and care coordination empowers mothers and adolescent girls with knowledge and access to quality health services to:

Improve antenatal and postnatal care for mothers and babies

Increase the number of women delivering with a skilled birth attendant

Improve transportation to mainland facilities during obstetric emergencies

Improve maternal and infant outcomes after birth

Reduce rates of early marriages and pregnancies

Reduce rates of school drop-outs of female students

Improve knowledge of personal health and HIV status

3. Describe the nonfinancial participation by sponsoring Club Rotarians in the project (ie how Rotarians will be involved).

The implementing club, Rotary Club of Mbita Mfangano, will support this project through the following:

Mobilize local community participation in the project

Volunteer at health campaigns and outreach services

Provide oversight for Organic Health Response with implementation of planned activities

Supervise and manage use of all grant funds

Provide ongoing, real-time evaluation of project and impact assessment through submission of timely reports

Create and submit final reports to the international club on grant activities, impact and use of funds

Disseminate project results locally, regionally and nationally at Rotary and other forums.

Conduct annual reviews and follow up reports to all for 5 years.

The sponsoring club, Rotary Club of Fort Collins, Breakfast will support the project through the following:

Conduct quarterly Skype calls to check-in and provide advice to Rotarians from RC Mbita Mfangano

Mobilize awareness of the project through international channels and provide RC Mbita Mfangano with contacts of partners to collaborate with and share results

Assist with dissemination of grant funds and review reports and evaluations of the project

Disseminate project results locally, regionally, nationally, and internationally at Rotary conferences/meetings and other forums.

4. How will the general public know this is a rotary-sponsored project? Please provide details of the publicity plan.

RC Mbita Mfangano will ensure OHR uses Rotary logos on all flyers and class materials, and proudly displays the Rotary banner at all health campaigns and outreach events in the community. A Rotary sign will be placed at the entrance of the Ekialo Kiona Center on Mfangano Island, the headquarters of Organic Health Response, to announce this project and Rotary's support. The Rotary logo will also be published on the Organic Health Response website.

In addition, all published work by the Organic Health Response on the Mfangano Health Network will highlight Rotary's support for this project.

5. Sustainability

- Local Leadership: This project will be implemented on the ground by a team of local Mfangano leaders and Rotarians with a proven track record of dedication to their community, honesty, and capability, including:

o Gor Benard Ouma: (Current President, RC Mbita Mfangano): As a former pastor, Gor comes with extensive experience with working alongside HIV-affected communities through faith-based worship. He has been a community organizer for the past 20 years and has a deep understanding of the socioeconomic and cultural factors impacting Mfangano residents.

o Richard Magerenge, (1st President, RC Mbita Mfangano): Richard is a lifelong resident of Mfangano Island, and small business owner (the Mfangano Island Beach Resort), with over 10 years of experience as a senior manager of community based health and education programming in partnership with local NGO's, the Ministry of Health, and international research organizations (including Oxford University, Kenya Medical Research Institute, and University of California).

o Robinson Okeyo, (Club Project Service Director): Robinson is a lifelong resident of Mfangano Island, certified with a Diploma in Community Development, and lead implementer of numerous Rotary grant projects on Mfangano and nearby islands.

o Pam Mohamed and Joyce Obanda: (Rotarians and Community Health Workers): Pam and Joyce serve as Community Health Worker Coordinators, directing training and supervision for over 50 community health workers who will comprise the ground force for this intervention.

- Ongoing Support:

o Several RC Mbita Mfangano members played a significant role in the Mfangano Health Network expansion by organizing and recruiting community members to join one of the new 114 Micro Healthcare Support teams. Having played a role in previous programming, RC Mbita Mfangano is the ideal organization to lead the efforts of this grant.

o With previous and ongoing commitment to this project, RC Mbita Mfangano is well poised to continue with this grant for a minimum of five years. The volunteers are committed for the long term with OHR and the Health Network approach.

o The Mfangano Rotary Club and OHR will jointly report on key metrics listed above.

- Local Ownership: All program activities will be coordinated and managed by the locally-owned and managed Ekialo Kiona Center at Kitawi Beach. This solar powered community center serves as headquarters for numerous health, education, and livelihood programs, and houses the broadcasting studio for Mfangano's only local radio station, EK FM. The 35 Kenyan staff members that run this center are from Mfangano and surrounding islands, representing and serving their community.

- Local Partnerships: RC of Mbita Mfangano have established longstanding relationships with the Kenya Ministry of Health, local government officials, and other community based organizations (CBOs). Two specific RC Mbita Mfangano partnerships include Organic Health Response and Sena Health Facility.

Organic Health Response:Contact: Kelsi Hines, Executive Director, khines@organichealthresponse.org, +17158218118Sena Health Facilty:

Contact: Habert Ochieng

- International Partnerships: OHR-EK has secured MOU's for research and funding support for this intervention from key international partners including the Segal Family Foundation, Kenyan Medical Research Institute, and University of California-San Francisco.

- Rotary Network: This budget and subsequent projects will be completed and augmented with support from a network of Rotary Clubs in Kenya and USA which have worked together to implement previous projects on Mfangano including: RC of Ft. Collins Breakfast, Glenwood Springs Sunrise Rotary Club, Denver Tech Center, as well as Rotary Clubs in Minneapolis and San Francisco.

6. Project contact - who in the club is the primary contact who will monitor progress, provide additional information if needed and submit the final report?

Robinson Okeyo,

Club Project Service Director, RC Mbita Mfangano

okeyojnr@gmail.com, +254.720.288.070

7. How will the club assure that the project is completed as proposed, funds spent appropriately, recognition of rotary visible, and reports compiled in timely manner?

RC Mbita Mfangano will serve as the implementing club, and will provide real-time monitoring and evaluation of this project. With project activities based on Mfangano Island, RC Mbita Mfangano is able to supervise all planning, activities, implementation, and grant spending, as well as prepare all reports for the sponsoring clubs. OHR-EK, RC of Mbita Mfangano, and RC of Ft. Collins Kenya have a proven track record on Mfangano Island of successful Rotary Grant implementation on Mfangano including:

- Rotary Simplified District Grant for HIV testing, sustainable agriculture, and women's crafts workshop in Mfangano

- Rotary Matching Grant for Organic Agriculture training and Reforestation program

- Mobility Device (Wheelchair and Walker) Collection and Distribution Project for over 75 disabled residents of Mfangano East with Crutches for Africa of RC of Mountain Foothills.

- Water Sanitation and Latrine Construction Project on nearby Remba Island

- "Purple Slip" Project at Mfangano Sena Health Center, where the club delivered prenatal packs to mothers who attended prenatal visits and delivered at the health center.

8. Provide project manager name and contact information if different than above

Same as above.

9. Cooperative organization:

Organic Health Response (OHR)-EK Center:

OHR is registered as a 501c3 Nonprofit in Colorado, USA

EK Center is registered as at Community Based Organization in Homa Bay County, Kenya

Primary Host Partner

District: 9212

Rotary Club of: Mbita Mfangano Island

Primary Contact: Robinson Okeyo

Email: okeyojnr@gmail.com

Primary International Partner

District: 5440

Rotary Club of: Fort Collins-Breakfast

Primary Contact: Larry J Salmen

Email: lsalmen@q.com

Project Status

Your project is "Fully Pledged". This means the amount of the pledges is equal to the total budget of the project. Now the project needs to be finalized and go through the approval process with The Rotary Foundation. This process gets started on the administration page.

Project listed for the 2016-17 Rotary Year.

Proposed Financing

Existing Contributions Towards This Project

Date

Cash

DDF

Total

Mbita Mfangano Island (9212)

19-Oct-16

$200

-

$200

Fort Collins-Breakfast (5440)

19-Oct-16

$4,000

$4,000

$8,000

Fort Collins (Foothills) (5440)

5-Jan-17

$1,000

$1,000

$2,000

Fort Collins-Breakfast (5440)

5-Jan-17

$1,000

$1,000

$2,000

Centennial (5450)

5-Jan-17

$1,000

$1,000

$2,000

Denver Tech Center (5450)

5-Jan-17

$3,000

$3,000

$6,000

Amount Requested from The Rotary Foundation

$5,100

$10,000

$15,100

Total

$35,300

Note: as of July 1, 2015 there is a 5% additional support fee for cash contributions. This fee does not appear in the financials above because it does not apply if the funds are sent directly to the project account (without going through TRF, and therefore without Paul Harris credit). Clubs sending their cash contribution to TRF must be aware they will have to send an additional 5%.

Project Supporting Documents


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History Log Entries

19-Oct-16

by Larry J Salmen

System Entry: Creation of project page.

15-Nov-16

by Joe Schon

We have approved this project for the requested D.5440 grant match.

5-Jan-17

by Larry J Salmen

System Entry: Pledge of $1,000 with $1,000 DDF by Bruce Hottman of the Rotary Club of Fort Collins (Foothills), District 5440.

5-Jan-17

by Larry J Salmen

System Entry: Pledge of $1,000 by Larry J Salmen of the Rotary Club of Fort Collins-Breakfast, District 5440.

5-Jan-17

by Larry J Salmen

System Entry: Pledge of $1,000 by JOhn Berry of the Rotary Club of Centennial, District 5450.

5-Jan-17

by Larry J Salmen

System Entry: Pledge of $3,000 with $3,000 DDF by Ralph Ogden of the Rotary Club of Denver Tech Center, District 5450.

5-Jan-17

by Larry J Salmen

System Entry: Project is now "Fully Pledged".

9-Jan-17

by Joe Schon

We have approved the DDF funding for all contributing Clubs for this project.

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