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Global Grant Proposal Form for Project G-1243 1. Host Partner Information
2. International Partner Information
1. Describe the benefiting community including its location, using any relevant geographic and demographic information (Please be as specific as possible). If the activity is a scholarship, enter "N/A". 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 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. 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 2. What community needs have been identified? If the activity is a scholarship, enter "N/A". 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 in 2016-2017. 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. 3. How are these needs currently being addressed with local resources and/or government agencies, NGOs, etc.? If the activity is a scholarship, enter "N/A". The Mfangano Health Network – Micro Healthcare Support Teams: Over the last 7 years, the Organic Health Response (OHR)-Ekialo Kiona Center has worked to develop and field-test an innovative approach to addressing these critical health challenges. In partnership with groundbreaking Microclinics International (MCI), OHR has designed a unique adaptation of the “microclinic” model to improve health outcomes on Mfangano. The approach is simple- we harness the power of existing social networks to activate community-level involvement in health coordination, monitoring, and mobilization. A “Micro Healthcare Support Team” is a therapy management collective comprised of 5-15 friends, relatives, co-workers and neighbors. Micro Healthcare Support Teams are trained and supervised by distinct community health workers, to keep all members strong and engaged together in lifelong health. 1. Summarize the proposed activity(ies) in 250 words or less, including the need it will address, the intended beneficiary(ies), and the potential benefits to the community. 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. 2. Please list any cooperating organization(s) or university(ies) involved in the proposed activity(ies). - 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. 3. Describe how the benefiting community will be involved in the activity(ies) (Provide specific examples). If the activity is a scholarship, enter "N/A". - 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 4. Has the benefiting community(ies) confirmed that it would like the activity(ies) to take place? Yes. LOcal leaders, and the local Rotary club have confirmed this need and the community's desire to participate. 5. Proposed Start Date: 1-JAN-2017 6. Proposed Completion Date: 31-DEC-2017 1. With which area(s) of focus is the proposed activity aligned?
2. Please describe how the activity(ies) will address the goal(s) of the area(s) or focus. 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 1. What will be the immediate and long-term outcomes of the activity(ies). 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. 2. Explain how all involved parties will act to ensure the sustainability of the activity(ies) and/or outcomes. 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 in Section D2 . - 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.
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