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

2019 Review

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.


Mageta Island Health Centre, exterior

Location of Mageta Island on Lake Victoria

Refurbishment of the Health Centre on Mageta Island in Lake Victoria

Funding summary:

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 the clinic.
The health centre is the only one for all 12,000 inhabitants of the island.
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.
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, as it 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.

Mageta Island Health Centre

Dilapidated health centre roof

The poor condition of the health centre

Despite the best efforts of the staff 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.

General ward

Maternity

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

Pharmacy cupboard

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

Clinic services board

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 safer, cleaner and better-equipped facility that will better serve the needs of the community

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.

Background

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.


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.

Your donations funded the purchase of an emergency ambulance to support the 12,000 inhabitants of Mageta Island

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.

Impact

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.

Outcomes

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.

Donate

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.



Mageta Island on Lake Victoria

Houses on Mageta Island

The main economic activities on Mageta Island are fishing and small-scale subsistence farming

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.


Photo courtesy of Global Fund/John Rae

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


Magnet Theatre Project

Summary

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

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

Challenges

There is still a huge need to reach young people through theatre and include governance and its effect on service delivery, particular in Kenya where there is massive corruption.

If the young people cannot relate corruption 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.

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.




Registered Charity no: 292058

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