A Community Health Transformation in Rural Kenya

Katie Martin

Senior Project Associate

Victor sharing a maternity register at Kilungu sub-County Hospital. Photo: Katie Martin/MSHNestled in the lush, terraced rolling hills of Nunguni, Kenya, Kilungu sub-County Hospital is a small 14-bed facility devoted to delivering high quality maternal, neonatal, and child health services to rural areas of Makueni County. Victor Omido (right) was stationed at Kilungu by the Kenyan Ministry of Health (MOH) and has been serving as a midwife at the facility for two years. In May 2014, he was selected by the MOH to participate in the pilot delivery of the LMG for Midwifery Managers Course, developed jointly by Management Sciences for Health and Amref Health Africa under the USAID-funded Leadership, Management & Governance Project.

During the course, Victor and 9 other Kenyan participants learned critical leadership, management, and governance (L+M+G) skills like resource mobilization, stakeholder engagement, monitoring and evaluation, and mentorship, among others. They each then utilized these skills to implement a six-month action plan, composed of innovative and locally tailored health solutions aimed at addressing a clinical workplace challenge and measuring health service results. Victor chose to address a challenge that many rural health facilities have been hoping to overcome – few women choosing to deliver with skilled birth attendants (SBA) in a safe setting.

By looking at key health indicators in his community, scanning his environment, and working with stakeholders, Victor selected priority actions to reach his desired results. He came to understand that pregnant women were often delivering at home due to community distrust of midwifery and the clinic. He noted that many cultures had misconceptions about the type of equipment that was used and what services were ultimately performed during labor and delivery.

Increase in the Number of Skilled Deliveries at Kilungu Sub-County Hospital

Thinking creatively with his team, Victor focused on developing community outreaches to ease their concerns and emphasize the importance of SBA deliveries. At the beginning of his project, which included his team’s implementation of community outreach strategies at the local market, Kilungu only delivered 34 infants with SBAs per month. By the end of six months, this number had increased by 91% to 65 deliveries per month. Using skills learned in the LMG for Midwifery Managers course, he was able to demonstrate to his community the importance of SBA deliveries. But Victor’s institutionalization of L+M+G practices did not stop with the conclusion of the course.

A Hospital Transformed by Leadership, Management & Governance Skills

L+M+G strategies have dramatically changed the way health services are delivered at Kilungu. Witnessing the dramatic results from his LMG action plan, Victor chose to continue using his new leadership skills in his workplace to address new challenges. After honing his mentorship skills in the LMG course, Victor noted that health workers from rural facilities in his sub-county often lack the practical on-the-job experience that working in a larger health facility offers. As a result, he decided to implement a two-week regional mentorship program, in which one health center worker per 26 rural health facilities visits Kilungu to receive on-the-job training in community outreach and various RH/FP services.

Last month, 17 health workers attended this training, which focused on long-acting reversible contraceptives (LARCs). Supervisory visits to the various rural health facilities are now conducted to ensure the sustainability of service delivery improvements. All of this could not be done without Victor’s astute resource mobilization skills, which prompted him to write a successful funding proposal for the program to the Clinton Health Access Initiative (CHAI). CHAI was impressed by this program’s initial success, and agreed to fund another initiative, Monthly Contraceptive Days. This outreach involves scheduled visits to rural health facilities to deliver integrated cervical cancer screening, antenatal care (ANC), and family planning services to 60-90 clients from hard to reach populations.

In the months since Victor’s LMG training, he has identified, planned, and implemented a myriad of other new initiatives and programs that have demonstrated organizational and clinical results at Kilungu. It is clear that his ability to proactively scan his environment for challenges, engage the appropriate stakeholders for input, plan collaboratively with his team, and monitor and evaluate success has proved to be an invaluable asset to Kilungu.

Looking Forward: Hospital Expansion & Regional Influence

Kilungu staff (Makosi, Victor, Moses, Faith) in front of one of the new facilities, currently in the final stages of construction. Photo: Katie Martin/MSHAll of this hard work has not gone unnoticed. By utilizing new L+M+G skills to solve workplace challenges with his team, Victor has become a recognized leader in his workplace. As a direct result of his LMG training and dedication to these new initiatives, Victor has been promoted to Reproductive Health Coordinator of the entire sub-county. Additionally, in an effort to provide space for Kilungu’s increased client load and to expand services (including cesarean section) for these clients, the Makueni County Government has decided to fund and construct three brand new facilities at Kilungu. The grand opening will be in the coming months and will be open to the community. Thanks to Victor’s vision and dedication to utilizing L+M+G skills to solving workplace challenges, Kilungu’s future is bright.