Mildmay in Kenya
Mildmay Kenya works to empower communities to deliver HIV health care services through support, education and training. We work to reach key affected and at-risk groups including young women, children, adolescents, MSM, and sex workers
HIV in Kenya 2018
There are 1.6 million adults and children living with HIV in Kenya
4.7% adult HIV prevalence (ages 15-49)
46,000 new HIV infections
25,000 AIDS-related deaths
69% of adults on antiretroviral treatment*
61% of children on antiretroviral treatment*
*All adults/children living with HIV
Source: UNAIDS Data 2019
The past year has been another challenging one for the Mildmay team in Kenya.There continues to be significant disruption and strikes from health workers who deliver universal healthcare services in Kenya.
Drug supply is also affecting the ability for health workers to provide even basic healthcare and there continues to be a significant challenge with corruption affecting many of the important areas of government services.
Despite of this our team continues to deliver services in increasing numbers. The Kenya Red Cross, which administers the Global Fund for Kenya doubled the size of the area to which Mildmay provides its HIV services.
Unfortunately, they were unable to double the size of the budget and so the small head office team who run operations out of Kisumu continue to try to do more with less.
We were pleased to see the first Tuk Tuk Ambulance finally delivered to Mageta Island. This important piece of equipment is part of the work that Mildmay is doing to support the local team of two nurses and twenty five community health volunteers to provide HIV support and maternity support services to an island population of over 12,000 people.
There are also no roads on the island, which is approximately eight kilometres long and one kilometre wide, and the health centre is located at the centre of the island.
We continue to work with the County Health Services to try to provide essential health equipment to the island and in the last year with the support of partners KMET and Kenya Red Cross, Mildmay was able to provide delivery equipment and fifteen hundred delivery packs.
Over the next year, working with our partners The Virtual Doctors, we hope to provide the first tele-medicine services to the island. This system has been trialled in Zambia and once funding has been raised to redevelop the system to work across multiple countries this will put the health team on the island in contact with doctors and consultants in their county hospitals and the UK.
We will run a pilot programme of this telemedicine service on Mageta Island. But first, to maximise its effectiveness, we need to refurbish the island's one and only health centre.
Refurbishment of the Health Centre on Mageta Island in Lake Victoria
Total refurbishment cost: £12,644
Total equipment cost: £11,907
Total project cost: £24,551
Aim of the project:
To refurbish the only health centre on Mageta Island to improve healthcare standards and encourage use of the clinic.
The health centre is the only one for all 12,000 inhabitants of the island.
A message from our Chairman
The services offered at the health centre include basic sexual and reproductive health services (immunisation, antenatal, postnatal, family planning) and other general outpatient services that include prevention and treatment of communicable and non-communicable diseases.
Find out more:
Mageta Island has the highest HIV and AIDS prevalence and child mortality rates in Kenya. Mildmay has been working with communities to deliver HIV-healthcare through support, education and training in remote, impoverished rural areas like Mageta in Western Kenya for over 15 years.
We now aim to go even further by partnering with another charity, the Virtual Doctors, to introduce a novel new telemedicine system trial on Mageta Island in Lake Victoria, to considerably strengthen general health services with the potential to roll out the system nationwide and thereafter into other countries in Africa and Asia.
But first, we need to refurbish the Island’s only health centre, which is extremely run down and dilapidated
A modest investment is needed to bring the health centre up to an acceptable, hygienic standard, prior to beginning the telemedicine trial.
We think Mageta Island is the ideal site to run a small-scale implementation of the telemedicine system to prove the viability of the project for the Kenyan government.
The poor condition of the health centre
Despite the best efforts of the staff and volunteers who operate the health centre, it is in poor condition, both in its fabric and its facilities and equipment. The building is over 60 years old and has suffered from long-term lack of investment by County Health Services, who have simply not had the funds available to invest in it.
The poor condition of the facility is discouraging to the island’s residents, and those that have the resources to do so will take the ferry to the mainland to seek treatment, which in turn, means less incentive to invest in the clinic, exacerbating its decline.
The poorest and most impoverished residents have no choice but to use the health centre, despite its condition and lack of modern and hygienic facilities.
The facility faces several and unique challenges unlike other rural facilities due to its geographical location (on a remote island) and the population targeted.
Accessing the facility for regular supervision and support remains a challenge for the County and Sub-County Health Management Teams.
What we will do
We want to refurbish the health clinic on Mageta Island in order to improve usage and therefore the general health of the population, and establish the Virtual Doctors pilot project there.
A facelift of the facility, including repainting, minor renovations like tiling of the maternity unit and the wards to improve on infection control
Minor renovations to partition the rooms for privacy since there is only one general ward that houses everyone that is admitted
Make the mother and child clinic baby-friendly with brighter colours and some murals, which would improve the overall service delivery
Improved support supervision
Regular Continuous Medical Education
Staff accommodation within the facility
Support for more health outreach activity
Mobilisation and sensitisation of the population to improve health-seeking behaviour
Why we need to do it
Because the health centre is not well equipped or in good condition, and is not a welcoming place, a large proportion of the island’s population avoid using it. Except for the poorest residents, who don't have a choice
Clinical equipment needed
Adjustable delivery couch
Movable medication trolley
Infant weighing scale
Oxygen cylinders (1 portable)
Electric suction machine
Who will benefit?
- The 12,000-strong population of Mageta Island
- Health centre staff
- County Health Services
- Volunteer doctors in the UK, Kenya and elsewhere, participating in our forthcoming telemedicine project
Expected outcomes are:
A robust healthcare system for pregnant women on Mageta Island that copes with emergency complications and where mothers can expect to give birth successfully the vast majority of the time
Increased attendance, with better health outcomes among the general population, but in particular, high-risk groups
Improved education regarding personal health among the general population, but particularly, high-risk groups
People in the community living healthier longer lives
Better trained, more responsive and productive healthcare workers will have gained a sense of pride in the improved effects of their work, feeling better-motivated
The health centre will be a benchmark for quality local healthcare facilities - a model that can be applied in other rural areas of Kenya
Mildmay will be able to establish the trial telemedicine project on Mageta. We believe that if we can run a successful pilot on Mageta Island, the project will succeed elsewhere in Kenya and other countries too.
During the 1952–1960 Mau Mau Uprising, the British colonial government used Mageta Island as a forced-labour and detention camp due to its isolation in inhospitable territory.
The detention cells were later converted into the health facility that now serves the whole island, established by the national government before the devolution of power and responsibilities to county governments in 2010.
Devolution has resulted in a sporadic and continuous health crisis in Kenya since the allocation for health is mostly for recurrent cost.
There is an ongoing problem with drug supply and investment in facilities.
Safe Motherhood Project
Snapshot of ongoing activities that support the Safe Motherhood Project:
We conducted 5-day Safe Motherhood training for 22 Community Health Volunteers and 4 local skilled birth attendants from Mageta Island, to include early danger signs in pregnancy and during labour, importance of antenatal class attendance, preventing mother-to-child-transmission etc. This training was conducted by 3 health care workers instead of two, the minimum required by the Ministry of Health.
John Richardson, Chair of Trustees, thanks our donors
Healthcare for pregnant women on Mageta Island is basic and struggled to cope with emergency complications. The result of this was an unnecessary loss of life to both newborn babies and mothers.
For pregnant women on Mageta, healthcare was very difficult to access, as there are no roads or cars on the island, and the health centre is some distance from where most people live.
We appealed to our supporters for help to purchase a Tuk-Tuk ambulance to provide emergency obstetric and maternity support to for the Island.
Before the arrival of the emergency ambulance:
The difficult terrain of Mageta Island meant that two-thirds of HIV-positive women on the island were unable to access vital pre and postnatal care.
Pregnant women had to walk for several miles to the island’s health facility because there is little access to motorised transportation and the only emergency vehicle is a motorbike, which cannot meet the need effectively or safely.
The health centre on Mageta Island has basic maternity care, but pregnant woman and girls struggle to access vital care and testing.
The project has provided:
The Tuk-Tuk ambulance was ferried across Lake Victoria to Mageta Island in a small boat
A modified Tuk-Tuk ambulance enabling vulnerable pregnant woman able to deliver their babies at Mageta‘s community health facility. The ambulance will be able to navigate the difficult terrain of the Island safely and will also be equipped to deal with on-the-road emergencies.
Vital postnatal care, including testing for HIV.
Training for 30 Community Health Volunteers (CHV) in emergency obstetric care. Each CHV reaches around 100 households.
Education for households on the importance of dedicated maternity services.
Testing for HIV is an important component of antenatal care. Women are tested when they go into labour as a further precaution. If a woman tests positive for HIV, intervention at this stage can prevent her from passing HIV to her unborn baby.
Education is also an important part of this project as there are cultural beliefs that health professional involvement is not necessary.
Men in particular needed to understand that the life and well-being of both the woman and child that is at stake.
More than 6,000 women are reached annually through this programme.
Reduction of maternal deaths in childbirth and transmission of HIV from mothers to babies, impacting on the health and lives of the 12,000 people living on Mageta Island.
Trained community health volunteers providing maternity and emergency obstetric care, applying their skills sharing their knowledge, benefitting the community as a whole.
The emergency vehicle is community property and the community is supported to run it sustainably as a vital resource for the Island.
A robust healthcare system for pregnant women on Mageta Island that can cope with emergency complications and can expect to give birth successfully the majority of the time.
Pregnant mothers supported throughout pregnancy and during childbirth.
Improved health among the general population, but in particular, high-risk groups.
Improved education regarding personal health among the general population, but particularly, high-risk groups.
People in the community living healthier, longer lives.
When the Tuk-Tuk ambulance is not being used for emergencies and obstetric interventions, community health workers use it as a mobile consulting room to travel around the island and bring healthcare to the villagers.
Your generous donations funded the purchase of the Tuk-Tuk ambulance.
Our plan is to purchase a second ambulance for the island's residents - one ambulance for 12,000 people is simply not enough, and a second vehicle would greatly increase the impact of the services the health centre could provide.
Added to this, we will continue funding this project along with other related ones to ensure that education and training are maintained.
About Mageta Island
Lying off the eastern shores of Lake Victoria adjacent to Siaya, Mageta Island is about 8km from end to end and about one kilometre wide at its widest. Its total surface area is around 6.6 square kilometres. It is located in Bondo district, one of the poorest districts in Kenya.
The main economic activities are fishing and small-scale subsistence farming.
Despite social, economic and political advances elsewhere in Kenya, the island community feels isolated and there is little development in infrastructure, health and education. The island is not connected to the electricity grid and inefficient solar power cells generate barely enough power to light 40w light bulbs.
Residents say it is too expensive to invest in the island since everything, apart from water and fish, has to be imported from the mainland. Those who have good houses have spent a fortune importing cement, roofing materials, sand and nails to put up the structures.
The lack of availability of economic resources and education is pushing most inhabitants of Mageta Island to follow traditional practices, which include wife inheritance, early marriages among girls leading to dropouts from school and risky sexual behaviours such as “sex for fish” in which female traders engage in sexual relationships with fishermen to secure their supply of fish, leading to sexually transmitted diseases. The island is home to over 12,000 people, 24.8% of whom are living with HIV.
Mageta Island has the highest HIV and AIDS prevalence and child mortality rates in Kenya
Maternal mortality exceeds the national average by 42% and half of these deaths occur after delivery. This area of Western Kenya also contributes to over 70% of new HIV infections in children.
Health, in general, is not as good among the island communities compared to the country as a whole. Mosquitoes and tsetse flies are abundant, spreading diseases like malaria and yellow fever. Tuberculosis is also widespread.
Travelling across the Island to access healthcare is challenging as there are few roads, difficult terrain and severely limited transport options.
To help, Mildmay recently purchased a Tuk-Tuk ambulance to significantly improve access to maternity care for pregnant women, protecting their lives and those of their unborn children, as well as helping to prevent the transmission of HIV from mother to child. When the ambulance is not being used for emergencies, it is taken around the island as a mobile treatment centre.
Global Fund HIV Programme
The Road towards an HIV Free Society
The Global fund HIV Programme, administered in Kenya through the Kenya Red Cross Society, undertakes to expand universal access to care and treatment services.
The programme aims to increase care and support for most-at-risk Populations and Prevention of Parent to child transmission (PPTCT).
It increases coverage of HIV testing and counselling, pre-exposure Prophylaxis (PEP) interventions while improving quality leadership and governance.
Mildmay Kenya as a sub-recipient of the fund and is working with Community Health workers in Samia, Teso South, Siaya and Bondo to advance care and support of the chronically ill, prevention of parent to child transmission, HIV testing and counselling as well as enhancing quality leadership and governance.
Community Health Workers (CHWs) with support from Community Health Extension Workers and the health facilities carry out Home Based Care activities. These include: Recruitment of clients for follow up, psychosocial support, home visits, referrals and health education.
The CHWs mobilise clients and community people to attend outreaches targeting people living with HIV/AIDSs, pregnant women for prevention of mother-to-child-transmission (PMCT) and men for PMTCT involvement.
They also mobilise community members for home counselling and testing by health care providers.
Examples of Global Fund programme activities that we've accomplished
(November 2019 monthly figures)
Reached 974 youth with My Health My Choice evidence-based intervention (EBI)
These are a series of dialogues in groups of 16 for 4 Sessions with 13-17 year-olds on reproductive health, sexuality, HIV, delay of sexual debut, effective communication with parents and behaviour change.
Reached 946 youth with Healthy Choices for a Better Future EBI
These are a series of dialogues with 10-12 year olds in groups of 16 for 7 sessions on reproductive health, sexuality, HIV and delay in sexual debut.
Reached 639 youth with SHUGA EBI intervention
SHUGA is a video based series that focuses on reaching 18-24 year olds with discussions on sexuality, drugs, peer pressure, HIV and risky sexual behaviour and how to mitigate it. It also provides life skills for negotiating for safe sex, HIV testing and referral and behaviour change.
Reached 60 parents of adolescent children Families Matter Program EBI
This EBI is meant to improve positive parenting and effective communication between parents and their 13-17 year old children on sexuality, sexual risk reduction - including accurate HIV info that can translate into delay of sexual debut. It is delivered in 7 weekly sessions covering two modules per session for 1 to 2 hours per session.
Conducted Health Care Workers training for 60 nurses and clinical officers on youth friendly reproductive health services
The trainees will then offer youth friendly services to the Adolescent we refer to their facilities and in turn offer services during our RH outreaches.
Conducted Peer Education Training for 63 youth from Bondo and Rarieda selected as Peer Educators
These are adolescents and young people Living with HIV who will support treatment literacy and adherence among their peers and offer Positive Health Dignity Programme sessions that have a minimum of 10 messages for positive living. They will also follow up the young people to ensure adherence to treatment.
We sent two of our youth group members for “Know your rights” training as facilitators
These are structured events that reach adolescents and young people (AYP) with information on basic human rights to include sexual and reproductive health rights, HIV/TB and the law, succession - especially for women and girls. These sessions are conducted by the trained young people and backed by legal clinics convened by A pro bono lawyer to identify cases for follow up and also clarify legal matters.
Conducted 10 “Know your rights” campaigns embedded within legal aid clinics to reach 431 youth and adolescents
Out of these, 5 cases were identified and taken up by a pro bono lawyer.
A total 1,444 youth reached in various AYP Reproductive health services integrated community outreach
- 56 girls were given HPV Vaccine
- 60 girls aged 15-19 years screened for pregnancy and 13 referred for antenatal clinic services and teenage mothers support group
- 1,444 got STI, Condom and HIV information
- 11 referred for STI services after screening
- 3 referred for further TB screening and services
- 938 tested for HIV and 17 referred for antiretroviral treatment initiation services and linked to peer educators for support
- 25 were treated for minor ailments.
- 95 girls accessed one-on-one “sister to sister” sessions and 69 of them got family planning services
- 21 were referred for PREP (which some facilities don’t have) – this is a facility based on one-on-one skill-based safer sex intervention for women that helps young women understand sexual behaviours, norms, beliefs, cultural practices that put them at risk of HIV and other STIs, giving them skills that help them reduce the above. This is done by a female health worker (nurse).
- 245 Community Health Volunteers (CHVs) engaged for home and community-based care (HCBC).
- Reached 4,992 people living with HIV (PLHIV) (3,439 female and 1,553 male) with home and community-based services against a target of 4,900 PLHIV.
- Conducted 8 quarterly health facilities review meetings.
- Conducted 6 support group meetings for 150 PLHIVs to include adolescents and children.
- Reached 4,522 people with HIV testing services, 11 of these were HIV-positive and were referred for ART treatment services.
- Monthly data collection with 245 CHVs were held in both Bondo and Rarieda sub-counties reaching a total of 150 community health volunteers
- Engaged 150 CHVs for HCBC
- Reached 3,098 PLHIV (1,947 females and 1,151 males) with HCBC.
- Reached 2,970 (1,225 males and 1,745 females) with HIV testing services
- 18 People tested HIV positive and linked to health facilities for treatment.
- Monthly data collection with CHVs were held in both Luanda and Vihiga sub-counties reaching a total of 150 community health volunteers (75 Luanda and 75 Vihiga sub-counties).
Magnet Theatre Project
Theatre is a highly-effective means of effectively mobilising and teaching large groups of people in a short period of time.
Young people are able to make informed choices when they are provided with the right information, the right way and at the right time - and there is no better way than through theatre.
Snapshot of ongoing activities that support the Magnet Theatre Project:
We conducted 5-day Magnet Theatre training for 10 young people who have been supporting the outreach sessions. The young people are meant to mentor their peers who will in turn continue to conduct with edutainment sessions at community level to mobilise young people to access RH/HIV information and services.
We conducted two Magnet Theatre sessions to support the mobilisation of young people to attend World AIDS Day. This yielded 215 young people attending, 49 girls accessing HPV vaccine, 32 were screened for cervical cancer, 15 accessed family planning services and 102 accessed HIV testing services.
Conducted a 2-day Sensitisation Workshop for 15 youth group leaders on HIV prevention, care and treatment so that they give the correct information whilst mentoring their teams for theatre.
We had a meeting with the Sub-County Health Management Teams to discuss program progress and challenges to future plans. This also provided a forum to make some members understand how they could use Magnet Theatre for health promotion in their various departments.
We conducted a one-day quarterly youth group leaders workshop for 10 leaders to reflect on the successes and mitigation of challenges in this programme.
The Magnet theatre project working with the local community in Siaya County, was envisaged to bring together young people to be able to discuss, access and contribute to the dialogue of HIV, SRHR (sexual and reproductive health rights) and demand creation and utilisation of the services related to HIV/SRHR.
Magnet Theatre intervention is designed to not only entertain and educate, but to involve audience members in the action and encourage the kind of participation and reflection that is key to sustained behaviour change. Magnet Theatre is a form of community theatre that typically takes place in outdoor, public spaces.
The hour-long performances explore issues affecting a community and encourage discussion and problem solving with audience members. The actors perform a drama that presents a dilemma based on community issues. The audience participates by offering suggestions to the characters or by taking the place of an actor and acting out solutions to the dilemma.
Magnet Theatre encourages audience members to discuss solutions and allows them to experiment in a safe environment, to encourage individual and community-wide change.
Magnet Theatre is different from other forms of community theatre because it targets and attracts a specific and repeat audience, takes place at a regular time at a specific venue, and serves as a forum for magnification of behaviour change.
Magnet Theatre has produced some of Mildmay Kenya’s most visible examples of behaviour change.
During the project period, over 16,000 young people were reached with HIV and SRHR information and services through the integrated community outreaches.
Several activities were arranged during outreach to saturate the young people with as much information as possible as well as ensure that they were linked to the services based on need.
Siaya county in Kenya is a poor region that falls far behind the national progress made in fighting HIV. The burden of HIV in Siaya stands at 24.8%. In the province where Siaya County is located, 6.2% of youth aged 15-24 are living with HIV. This is three-times higher than the national youth HIV prevalence rate.
We are grateful to the Make a Difference (MAD) Trust for supporting this project in 2019
Thanks to this support, we have, additionally, been able to incorporate music, drama, poetry and other project activities which have made them more vibrant.
The health promotion department of the Ministry of Health has engaged with the project and learned better ways to reach youth.
“This project you are doing in the village, has made it easy for my officers to give health talks in a very simple and fun way” Says Chieng’ The County Health Promotion Officer in Siaya County.
Because of MAD Trust funding, Mildmay has been invited by several youth groups to mentor their peers and we have reached 50 more young people through 'Trainers of Trainees' than the project originally envisaged.
The “KAA RADA KUWA SMARTTA” programme (an urban dialect expression meaning be careful, be wise) is an educational theatre project targeting Kenyan young people in Siaya County.
The project uses performances and community theatre to raise awareness and understanding of sex, sexuality and HIV by retelling the true stories of young people. Through this engagement we help children and young people access HIV testing, treatment and sexual health services.
This project will increase the number of children and young people in Siaya county who access HIV testing and treatment and sexual health services.
Performances will also promote diversity, compassion and understanding, and encourage networking between young people to advocate for better HIV and Sexual and Reproductive Health Rights (SRHR) in their area.
Through theatre, we want to inspire young people to take action and speak up about barriers to HIV prevention, care and treatment in Siaya county.
Magnet Theatre Project objectives
Objective 1: To increase the number of young people (10-25) in Siaya County who access HIV testing and increase the number of young people with access to medication
During the period, the Magnet theatre groups mobilised young people aged 10-25 years to access information on HIV, SRH during the community based-outreaches, particularly HIV information and testing services. A total of 16,800, received HIV education while 12800 received actual testing services with 33 Diagnosed with HIV and linked to HIV treatment and care.
The young people living with HIV have also been linked support groups where they can access psychological and adherence counselling whilst sharing experiences and follow-up by their HIV positive peers.
We have also trained some of them on PEER EDUCATION and Mentored them on Magnet Theatre service delivery so that they use the skills during their support group meetings to pass information on treatment literacy and adherence in interesting and captivating ways.
Objective 2: To increase the knowledge of sexual and reproductive health rights of 15,000 young people in Siaya County) knowledge of SRHR and ‘Theatre of the Oppressed’ each year.
The level of knowledge on SRH issues for 16,800 young people was improved by attending the Magnet Theatre sessions alongside being given information on human rights, HIV and Law.
The messages were developed in conjunction with field staff, theatre 'Trainers of Trainers' (ToTs) and the reproductive health coordinator.
There was increase in access of SRH services among young girls and women with the clinical team setting aside special days for SRH information sharing within selected facilities that the young people preferred.
These forums were also used to drive cervical cancer screening and prevention campaigns which saw 243 girls access the HPV vaccine. 65 underage girls were also referred for antenatal care and enrolled into teenage mothers support groups, we enrolled a further 623 on family planning in the process of comprehensive outreaches.
Objective 3: To increase young people’s creativity, imagination, critical thinking skills on SRHR. We want to produce 138 (18 trainers of trainers and 120 theatre troupe trainees) experts in SRHR who can advocate and leverage demand for SRHR services for young people each year
10 representative members of Ulusi Youth group, Bondo Youth Goup, Bondo Comedian Youth Group, Amkeni Youth group and a network of youth groups called Rarieda Community Network of Youths (RACONET) were trained as theatre group trainees. Additionally, 2 members from the groups were trained as ToTs. These trainees and TOTs further mentored 5 members each per group making an additional 50 Magnet Theatre providers.
The young people currently create their own content whether satire or comedy and stage shows at the market places, football tournaments, landing beaches etc. which are the common social places and events to reach young people in Siaya County which is largely rural.
This has culminated to vibrant villages with village, religious and administrative leaders tasking to include other organisations and requesting more services than we envisaged. We hope to continue mentoring more youth to support the expansion of our work.
Objective 4: To raise awareness about SRHR and HIV issues in the broader public among 15,000 young people, using the ‘Theatre of the Oppressed’ format, each year.
These performances will mobilise not only the players, but also the audience and actors to critically reflect on SRHR issues facing adolescents and young people.
The project capitalises on community events like sports, and national health and patriotic days to pass on messages related to HIV and SRH. The Magnet Theatre technique took centre stage as it allowed the audience to be involved in the problem solving. This allowed us to collect opinions directly from the people without getting into so much research details in a short while.
We combined 6 of the sessions reaching 300 girls and boys with “know your rights” campaigns where we had pro bono lawyers who came and talked about HIV and SRH rights in relation to access to health services and gender-based violence.
This led to a legal clinic, due to the violations that were reported by young people. We have since referred 5 young girls for legal redress due to defilement cases.
Any support will go a long way in sustaining the gains brought about by this project. Even though we have contributed to the fall in new HIV infections in Siaya County, to sustain these gains ,we need keep the project going year after year.
There is still a huge need to reach young people through theatre and to include governance and its effect on service delivery,.
If the young people cannot relate governance and its effect on access to quality health care, education, employment or empowerment opportunities, then the opportunity will be lost to see an empowered health generation.
Besides this project, there is little investment from the government in the arts, whether visual or performing arts.
Registered Charity no: 292058