MUKURU PROMOTION CENTRE

PROPOSAL TO ENHANCE ACCESS TO QUALITY & AFFORDABLE COMMUNITY BASED HEALTH CARE FOR THE MUKURU COMMUNITY

General Information

o Name of Organisation o Mukuru Promotion Centre

o Project Title o Enhance Access to Quality & Affordable Community Based Health Care for the Mukuru

Communityo Project Location

o Mukuru slum villages in the Industrial Area, Nairobi o Contact Person

o Sr Mary Geason: Tel: 0727 752294o Contact Information: Physical Address, Postal Address, Phone Number and Email Address

o Likoni Road Bypass, opposite Express Kenya, Industrial Area, Nairobi.o P O Box 17837 – 00500. Phone number: 020 2044428. o Email Address: director @mukuruex.org

o Project Timeline o Project Timeline: 2012-2015

o Amount Requestedo Ksh 1,500,000 annually for 2012-2015 representing 50% of the required fundingo Other donors will be approached to fund the balance

Executive Summary:

Mukuru Promotion Centre is a church based charitable organization that was established by the Sisters of Mercy in 1985. The organization started as a temporary school in the heart of the Mukuru slums and its key objective then was to provide education to the children of Mukuru to get them off the streets. Since its inception, MPC has expanded a great deal and now operates several projects that focus on four key areas: Education, Health, Vocational Training, and Social Rehabilitation.

MPC’s vision is: In partnership with the Mukuru community, Mukuru Promotion Centre envisions the Mukuru community attaining sustainable and holistic human development and self reliance. The overall goal of all MPC actions in 2012-2015 as specified in our Strategic Plan will be to continue its contribution to the alleviation of the dehumanizing effects of poverty and disease through interventions that lessen the burden of living and liberate the population to focus on development initiatives.

Significance of the Project:

Mukuru Informal Settlement: the Mukuru slum lies within Nairobi’s industrial area with an estimated population of 600,000 people, majority of them being women and children. Most households within this

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community are headed by women. Like all other informal settlements in Nairobi the Mukuru slum is severely overcrowded, insecure and lacks basic health and sanitation facilities. An average of 5 to 6 people live in a room that measures approximately 3 to 6 square meters. MPC has offered community based health services to the community for years, and during the last four years, nearly 60,000 clients benefited and nearly 1000 community health workers were trained. The current project aims to enhance access and increase the number of clients to 18000 per year, 66,000 over the four years, 2012 – 2015.

Problem Statement:

Water is purchased from vendors at high costs and is therefore a very scarce resource. Heaps of garbage are a common sight within this area blocking most of the drainage channels. Lack of sanitary facilities to dispose human waste and garbage has led to serious environmental and health hazards including high incidence of diseases like typhoid, cholera and diarrhea especially among young children.

The majority of the residents are poor, unemployment levels are high (especially the youth). Many work as unskilled casual labourers earning less than $2 a day. As in most developing countries, Kenya faces a big challenge as far as provision of affordable health care for its people is concerned. Quality health care services are basically only available in private hospitals in Kenya and these facilities are beyond the reach of the informal settlement population. Government facilities within these areas are ill equipped to handle any serious ailment as they lack personnel, drugs and other medical equipment. The Mukuru community members often resort to unregistered pharmacies and quack medics for many of their health care needs. The only alternative are the few faith-based and donor sponsored health care facilities within the catchment areas. The health services under Mukuru Promotion Centre were instigated in response to this dire need.

Project Objectives:

Objective 1: Increase the number of clients that access the Community Based Health Care Program. Two nurses, assisted by Community Health Workers, provide services in eleven slum villages on a rotating basis.

Increase from 15,000 (2012) to 18,000 (2015) clients per year to benefit from the community based health care program

Reduced mortality rate due to early diagnosis and intervention

Objective 2: Increase access to clean water for Mukuru community

3 village communities(approximately 300 households) have better access to clean water annually with the provision of 3 community based water tanks (12 installations, 1,200 households over 4 years)

Reduction in the incidence of preventable diseases Improved sanitation and general hygiene practices in the client community

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Objective 3: Reduce incidence of illness and undiagnosed health problems in primary school children

4,500 primary school children benefit annually from regular health checks and follow-up if necessary

450 Early Childhood Education and Development (ECED) children per year are screened for full immunization; nutrition status; birth registration.

Reduced incidence of sick days due to better health: reduce from 9% (2011) to 5% (2015)

Objective 4: Improve health of children in the 4 MPC Early Childhood Education and Development (ECED) Centres through education of caregivers

200 care-givers of ECED children (50 per school) attend a training three times per year (once per term), on topics such as how to identify serious illness in children; nutrition; safe water and sanitation; hygiene.

Reduced incidence of preventable diseases in ECED children

Objective 5: Increase effectiveness of Health services through capacity building

2 Nurses and 120 Community Health Workers benefit from updates/refresher courses

Health Workers provide up-to-date health information and treatment

Project Implementation and Management Plan:

Objective 1: Increase the number of clients that access the Community Based Health Care Program. Two nurses, assisted by Community Health Workers, provide services in eleven slum villages on a rotating basis.

Weekly, each of the two nurses, along with the mobile dispensary, visit one of eleven bases in the eight villages in Mukuru Community. They meet with the Community Health workers (who typically live in the village visited) who have mobilized clients who need medical attention, and who are not capable of visiting MPC’s own clinic located on St Catherine’s school compound. The nurses perform a general assessment and if in their opinion the administration of drugs will provide resolution they provide the patient with the medication. If, in their opinion, that the patient needs further medical treatment they arrange with family/friends/neighbours to have the patient transported to the MPC Clinic or to a hospital.

Objective 2: Increase access to clean water for Mukuru community

In conjunction with the Area Chief and the Village Health Committees (established in 2009/10/11 by MPC) select the most needy villages to receive water tanks. In collaboration with

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the Village Health Committees locate and install water tanks. Train and facilitate the purchase and sale of water to the local population with the proceeds being used to purchase more water and to upgrade other infrastructure needs within the community as agreed by the community members.

In collaboration with the community health workers, village health committees and village authorities, organize monthly “community action days” whereby the community benefits from education on public health issues; clean-ups; proper disposal of waste.

Objective 3: Reduce incidence of illness and undiagnosed health problems in primary school children

In conjunction with Child Fund Kenya and the District Public Health Office, school medical camps are organized once per term. This activity reaches a total of 4,500 MPC primary school and ECED children who undergo general health checks once per term. The exercise is conducted with partners: the District Public Health Office (DPO) and Child Fund Kenya (CFK). The reach of the total exercise is to 6,000 children in 34 schools in Mukuru. It is conducted with health professionals from MPC, CFK and seconded DPO staff to participate. Children with health problems are referred to appropriate health services for treatment

Objective 4: Improve health of children in the 4 MPC ECD Centres

200 care-givers of ECED children (50 per school) will be invited to attend a training three times per year (once per term). The training will be conducted by officials from the Department of Public Health, and the topics covered will empower parents/care-givers to recognize symptoms of serious illness and so seek early treatment. Education on safe water and sanitation will empower them to treat water appropriately before drinking, and ensure safe disposal of human waste, thus reducing the incidence of water-borne diseases.

Objective 5: Increase effectiveness of Health services through capacity building

The nurses and community health workers, in consultation with MPC, will identify and attend appropriate seminars/training opportunities to continue to build their capacity to deliver quality health services, education and advice.

Staff/ Administration The Program is overseen by the Coordinator of MPC Health Services 2 Home based care nurses

o Responsible for the smooth operation of the Home based care program.o Responsible to deliver curative and preventive health care services to the Mukuru

community (within the villages)o They are accountable for the drugs and supplies of the serviceo They will extend their services to the bedridden and those who are unable to reach the

Mary Immaculate clinic.o Ensure proper records keeping and submit monthly reports to the in-charge.

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o Participate in medical camps organized by the department.o Work closely with the trained Community Health workers to offer intensive health

education and pioneer in water & sanitation activities in the villages.

Community Health Workers – Casual workers – two per day assist the Home based care nurses. They are key personnel to assist in the “community action days”.

1 Driver – part timeDuties include: transport the nurses to the various bases within the villages, and drive the mobile dispensary that carries the drugs, lotions and medical supplies.

The MPC Project Director- oversees overall program development and operations and plays a key role in establishing and maintaining links with key donors, and other stakeholders.

MPC operates centralized Finance, Human Resource and Procurement functions. These functions are all essential components in the project.

The Human Resource function will handle Staff recruitment, Training and Development, Remuneration & Welfare while all the financial issues are handled by the Finance Department.

Project Partners: Child Fund Kenya works with MPC as a partner in implementing the school health program and ECED program.

Government of Kenya provides vaccines, TB drugs, and provides assistance with personnel for School Health program.

Project sustainabilityThe Community Based Health Care program has been run almost entirely on donor funds. From 2012, clients are being asked to pay 20/- per visit. MPC needs to constantly establish new partnerships and encourage sponsorship from both local and international donors in order ensure continuity of the community based health program.

Project Monitoring and Evaluation:

Monitoring As indicated above under staff/ administration, the key individual in the monitoring function will

be the Health Coordinator. She will work closely with the Project Director / Deputy Director to ensure the smooth running of the health program. The Coordinator will monitor the program daily i.e. ensure that the staff attend to their duties as required. She will ensure that rules and procedures are adhered to, updated records kept and that the program is implemented as planned.

The Coordinator will meet the staff on a monthly basis to discuss work progress and discuss challenges and she will be required to report on the same during the monthly Heads of Departments meetings.

The Coordinator will submit quarterly reports to the MPC management

Evaluation

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At the end of each year, an evaluation will be carried out to measure the success of the program against the set targets and goals. In addition, the services offered will also be assessed against emerging or new developments in the medical field. The evaluation will involve open discussions with the client community and other stake holders.

Documentation and Sharing Results:

The data collected will be analyzed annually, and a report will be prepared and shared with the donors and other stakeholders. This evaluation report will be utilized by the project implementers to improve on project execution in years that follow. Sharing our results also through: newsletter and Annual Report.

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MUKURU PROMOTION CENTREProject Budget:STRATEGIC PLAN: 2012-2015 SERVICE AREA: Health

Strategic Thrust: Enhance access to quality and affordable health care.

BUDGET 2012-2015    Annual Budget  

PersonnelNumber Monthly Budget 2012 2013 2014 2015 Totals

Nurses 2 60,000 720,000 792,000 871,200 958,320 3,341,520 Driver(Half Salary) 1 10,000 120,000 132,000 145,200 159,720 556,920 Community Health Workers (4 CHWs everyday @ 250/= Each) 80 20,000 240,000 264,000 290,400 319,440 1,113,840

Total Personnel Costs 83 90,000 1,080,000 1,188,000 1,306,800 1,437,480 5,012,280

Medicines 60,000 720,000 792,000 871,200 958,320 3,341,520

SanitationWater tanks 3 37,500 450,000 495,000 544,500 598,950 2,088,450 Installation Costs 3 25,000 300,000 330,000 363,000 399,300 1,392,300

Total Sanitation 62,500 750,000 825,000 907,500 998,250 3,480,750

School Health Checks(Thrice Per Year)

Mobilisation Costs 4500 12,500 150,000 165,000 181,500 199,650 696,150

Capacity Building1. Nurses Refresher Courses(Twice a year) -Transport 2 100 1,200 1,320 1,452 1,597 5,569 -Refresher course fees 4 1,667 20,000 22,000 24,200 26,620 92,820 2. Community Health Workers(Bi-annual) - -Facilitation Fees 4 2,667 32,000 35,200 38,720 42,592 148,512 -Refreshments 120 4,000 48,000 52,800 58,080 63,888 222,768 -Stationery 120 4,000 48,000 52,800 58,080 63,888 222,768 -Transport 120 6,000 72,000 79,200 87,120 95,832 334,152 3. Care Givers(Thrice Per Year)             - -Transport 200 10,000 120,000 132,000 145,200 159,720 556,920 -Refreshments 200 10,000 120,000 132,000 145,200 159,720 556,920 -Stationery 200 10,000 120,000 132,000 145,200 159,720 556,920

Total Capacity Building 48,433 581,200 639,320 703,252 773,577 2,697,349

Community Action Days(Once a month)

-Garbage bags 200 1,000 1,100 1,210 1,331 1,464 5,105

-Refreshments 40 4,000 4,400 4,840 5,324 5,856 20,420

-Mobilization 40 6,000 6,600 7,260 7,986 8,785 30,631

Total Community Action 11,000 12,100 13,310 14,641 16,105 56,156

Other Costs

-Fuel and Vehicle Maintenance   10,000 120,000 132,000 145,200 159,720 556,920

-Stationery   5,000 60,000 66,000 72,600 79,860 278,460

-Airtime   2,000 24,000 26,400 29,040 31,944 111,384

Total Other Costs 17,000 204,000 224,400 246,840 271,524 946,764

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MUKURU PROMOTION CENTRETotal Costs 301,433 3,497,300 3,847,030 4,231,733 4,654,906 16,230,969

Allow 10% Administration Costs 30,143 349,730 384,703 423,173 465,490 1,623,097

Total Project Costs 331,576 3,847,030 4,231,733 4,654,906 5,120,396 17,854,066

Community Contribution 14400 24,000 288,000 432,000 576,000 720,000 2,016,000

Project Deficit 307,576 3,559,030 3,799,733 4,078,906 4,400,396 15,838,066

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Additional Information:

2. Mukuru Promotion Centre is also involved in other health services, with partners as follows:

1. CHILD SURVIVAL PROGRAM (Funded by partner, Medicines for Humanity)Intervention Area: Clinical Services For Children And Pregnant Women

Goals:

i. Identify and treat 420 children under 5yrs; 165 children 6-12yrs; 85 children 13-18 yrs. Total of 670 children per month; 8,000 per year

ii. Identify and provide antenatal services to 40 pregnant women per month; 480 per year.

1. Intervention Area: Improving Effectiveness Of Community Health Services

Goal: 60 Caregivers receive training monthly; 60 pregnant women receive training quarterly; 240 Community Health Workers undertake refresher courses

Totals: 720 Caregivers, 240 pregnant women and 960 CHWs trained in a year

Topics: Child and maternal health, community health monitoring, growth and development of the child.

1 Consultant Pediatrician: (Part time). 1 Nurse 1 Data Clerk 1 Cleaner (full time) - His key responsibility is to ensure that the clinic facility and the

surrounding grounds are kept clean and orderly. He will ensure proper disposal of clinical waste.

2. GENERAL CLINIC SERVICES: PREVENTIVE AND CURATIVE HEALTH Increase the number of clients that access the Mary Immaculate Clinic for preventive and curative health services

Objective 1.1: 100 clients daily, benefit from general preventive and curative health services. Most common diseases are treated, e.g. Respiratory tract

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infections; diarrhea; malaria; skin infections; parasitic worms; sexually transmitted diseases

Objective 1.2: Facilitate referrals i.e. to ensure that, cases that cannot be handled at the clinic are referred to appropriate health facilities for further intervention.

Objective 1.3: 300 clients per year benefit from testing and treatment at the Tuberculosis (TB) clinic at the centre.

3. VOLUNTARY COUNSELLING AND TESTING FOR HIV (Funded by St Elizabeth School of Community Health and Social Work, Slovakia). Goals

i. 2,500 clients per year receive Voluntary Counseling and Testing for HIV.ii. 175 clients per year referred to a Comprehensive Care Clinic for ongoing

treatment

iii. Conduct HIV/Aids prevention sensitization activities

4. NUTRITION PROGRAM (Funded by St Elizabeth School of Community Health and Social Work and in collaboration with the Kenya Ministry of Health)

Goal: 100 malnourished children under five are stabilized per year

Anticipated Outcome or Results from above programs: Reduced infant mortality rates

Less cases of malnourished children.

Increase in the incidence of healthy new- born children

Reduction in still births and other complications during delivery for the mothers. Increase in the number of people who know their HIV status

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