SWAP has since 2007 established a research department with technical support from CDC Atlanta undertaking various effectiveness studies, collecting both quantitative and qualitative data to evaluate the health and economic impact of some of SWAP’s interventions and its distribution model. The research findings keep SWAP informed and its findings are also shared with the community leaders, international conferences, journals and publications. These findings have been instrumental in informing policies and implementation models worldwide.
Testing Means to Scale Early Childhood Development Study (ECD)
Funding from NIH with RAND Corporation as Prime recipient. The study tests different potentially cost-effective delivery models for an ECD intervention with a curriculum that integrates child psychosocial stimulation and nutrition education. Research started with a baseline survey. SWAP is implementing this study in Homabay County (South and East RachuonyoSub Counties) and Vihiga County (Sabatia Sub County). Community Health Volunteers (CHVs) have completed training of 16 sessions of the international ECD Curriculum. CHVs are doing parent sessions and visiting households. Follow up survey was completed in November 2019. Booster sessions are currently ongoing.
Cups andCash for Girls Trial
A partnership consortium with LSTM, CDC, KEMRI and GOK. The study provides Moon cup and cash transfer to reduce sexual and reproductive harm and school drop-out among school girls in Siaya County.96 day secondary schools randomly selected and 4,000 girls enrolled in the study and followed for 4 years. 4 treatments arms being measured (cash, mooncup, combined & control).SWAP is responsible for annual WASH surveys at schools and training of the girls on puberty, hygiene, use of the menstrual cup, financial literacy. Girls receive KES 1,500 per term in the cash and combined arms. SWAP participated in the development of the national policy and strategy of menstrual hygiene management.In 2019,SWAP started selling the Menstrual cup.
Afya Credit for Improved Maternal and Child Health
A partnership consortium with Stockholm Environment Institute, Nailab and SWAP. It isfundedby Bill and Melinda Gates Foundation. The study is evaluating the impact, cost effectiveness and sustainability of conditional cash transfer in retaining rural women in the continuum of care during pregnancy, birth and post-natal period. It has enrolled 5,488 mothers across 48 health facilities in Siaya County. Intervention arm get KES 450 for transport (2,532 pax) and control arm get KES 50 airtime (2,956 pax).
A 5 years collaborative initiative with KEMRI, CDC, MOH and MOE. The study is evaluating the Point-of-Care Circulating Cathodic Antigen (POC-CCA) assay for mapping and monitoring mass drug administration (MDA) for Schistosoma mansoni control program in western Kenya. It targets children between 9 and 12 years old in 45 primary schools in Siaya County. Completed Urine and stool sample collection in 45 primary schools in May and June 2019. Treatment of positive cases is done in collaboration with MOH.
Morbidity Operational Research for Bilharzia Implementation Decision (MORBID) study
A collaborative initiative with CDC, SWAPand TFGH– NTD Support Centre andfunded byUSAID.The overall project aims to identify infection levels of S. mansoni and S. haematobium below which there is little, or no, detectable schistosomiasis-associated morbidity in 45 villages in Siaya (29) and Vihiga(16) Counties.The overall number of participants enrolled since inception is 6,610 (Pre School Age Children=1,358; School Age Children=2,017, Teens =1,322, and Adults =1,913).
Routinely sample collection is urine and stool, but for a selected cohortvenous blood is collected. Samples are processed and microscopy done at the DVBD (MOH) and SWAP Parasitological laboratories.
Consultancy services is offered to School Water Sanitation and Hygiene plus Community Impact Project (SWASH+) funded by Bill and Melinda Gates Foundation by the Country Director with 20% level of effort. CARE Kenya implemented the SWASH+ phase II Project whose aim wasto improve the sustainability of school water, sanitation and hygiene (WASH) in order to effectively implement the Kenyan National School Health Policy. The project utilized evidence and learning from research to target key decision-makers at Ministry of Education (MOE) and Ministry of Health (MOH). The continuation phase between 2016 and 2019 was aimed at Stakeholders acting on available evidence through instituting policies to improve affordability and choice for sanitation in Kenyan schools. The objectives include: Decision-makers have access to data on use and sustainability of urban school sanitation options; Decision-makers have access to data on costs for urban school sanitation options; and the MOE has clear policies and procedures for procuring and regulating private sector sanitation services in schools.
Sanitary Platform in Health Care Facilities (HCF)
This study is evaluating the Feasibility and Acceptability of Novel Covered Sanitary Platforms in Healthcare Facilities in collaboration with CDC in Kisumu County (18 HCFs in Nyando Sub County and 19 HCFs in Nyakach Sub County). Baseline survey completed and disseminated at County and Sub County HMTs. Installation of SATO completed in 18 intervention clinics in Nyando and Nyakach Sub Counties. Follow up survey completed in November 2019. In 2020, installation in the other 50% at 19 health facilities in Nyando and Nyakach and ongoing monitoring. Project will end in September 2020.
Childhood Diarrhea and Drinking Water Study
A partnership between University of Illinois at Chicago and Portes Foundation. Evaluating the impact of childhood diarrhea in relation to improved drinking water using solar disinfection and normal chlorination.105 households with at least 2 children below 5 years mapped in Nyando Sub County. Assigned households to intervention arms and trained them. Completed final round of follow up visits and sample collections in November 2019, includinganthropometric and stool analysis followed by analyzing of data and dissemination of study findings. KEMRI supported processing of the stool samples. The study will end January 2020.
Community Scale Solar Powered Water Treatment
A partnership between University of Illinoisat Chicago and Bill and Melinda Gates Foundation. Scaling the solar power water treatment using ozonation in two urban settlements, in Kisumu County. A pilot of the solar water treatment completed in Ahero SWAP model village. Experiments, water testing and preparation ongoing and meeting with leaders and authorities for approval. In January 2020 the implementation will kick off and the project will end in August 2020.
Chronic Kidney Disease Study
A study in collaboration with the University of Illinois at Chicago. The main objectives of the study are to: characterize the prevalence of chronic kidney disease of unknown origin among adult residents of Muhoroni Sub Countyin Kisumu County and to characterize the work of Muhoroni Sub County sugar cane cutters. Protocol submitted to Maseno Ethics Review Committee for approval.
WASH and Waste Management in Health Care Facilities – Rarieda Sub County
A partnership between Vox Impuls Foundationand CDC. A baseline assessment was done of WASH and waste management in 27 health facilities in RariedaSub County, Siaya County.A WASH stakeholders meeting held to share the baseline data and to seek support from the stakeholders. Short term interventions started byputting desired WASH infrastructure in place and training of health care workers and community health volunteers on hygiene promotion and social behavioral change communication. SWAP plans to do an end-line survey in August 2020.
SWAP acquired land at Ahero, about 100 meters from the Nyando River to put up a model village which is intended to showcase the health interventions that SWAP deals with in the community. These include; Safe Water system products, Indoor Air Quality (IAQ), improved traditional kitchen and a Jamii Center. Inside the model village the sky hydrant was installed with funding and support from Janivo foundation, Aquaya Institute, Global Water challenge, Procter and Gamble, IPA among other private well-wishers. The system draws water from the river using a fuel powered pump. The water is filtered and used to be sold to the community at very low cost. However the County Government installed tapped water at households and as a result the water service was no longer relevant.
The model village receives a lot of visitors from all over the world and on one such occasion the Dutch Ambassador toured the facility and planted a tree. The center also has a training / meeting room which is often used by other partners including the Ministry of Health. There is a clean toilet with a hand washing facility for demonstration. Solar has been installed to provide clean energy. The kitchen is used for cooking and for demonstration, showing the clean improved cook stoves.
Inside the village there is a Jamii Center, where Community Health Promoters operate from. They perform door to door social marketing of health products and health education. The community can access this center for health products and information.
Leaders Orientation workshops This is a one day meeting with opinion leaders in a District and its purpose is to orient leaders and introduce them to the SWAP’s model, its staff, the basket of goods, share research findings and get the leaders involvement and support to mobilize the communities to adopt healthier behaviors. Targeted leaders include the Provincial Administration, Churches, Local Authorities and Ministry of Public Health and Sanitation.
SWAP creates awareness to HIV support groups and builds their capacity.
Groups targeted are widows, people living with HIV, home based care groups, youth groups, orphan support groups and other self help groups.
The purpose of this project is to provide a rapid integrated response to cholera outbreaks to reduce morbidity and mortality, and prevent the spread of illness. The project was initiated in 2006 with funding from Global Disease Detection and the Integrated Diseases Surveillance and Response programs at the Centers for Disease Control and Prevention. To implement this project, SWAP partners with the Ministry of Public Health and Sanitation, Population Services International (PSI), and the Red Cross. Response activities have two principal components: Training of personnel from the Ministry of Health, Red Cross, local government personnel, NGO personnel, schoolteachers, and others.Distribution of water treatment and hygiene products.
Distribution Model of Health and Hygien Products
Distribution model of health and hygiene products which are sold from door to door by community health volunteers to improve health while they generate income. SWAP focuses on fast moving, local available, affordable and profitable quality products. Kisumu Office sells to partner organizations and walk-ins and small and medium enterprises in local market places. Products are as well sold during emergencies such as floods, cholera response and other calamities. Products include water treatment chemicals, ceramic water filters, drinking water storage vessels and hand washing stations, bar soap, detergent, sanitary pads, menstrual cups, diapers, deworming tablets, fortified flour, condoms, cook stoves, mosquito nets, mosquito repellent soaps and solar lamps.
SWAP has been supporting orphans and vulnerable children with psycho-social support including counseling and referrals, school fees and requirements. SWAP further offers support to approximately 100 desperate orphans and vulnerable children per year by providing counseling, referral and clearance of areas of fees. SWAP encourages cost sharing with the caretakers.
Orphans, Vulnerable Families and Emergency Response
Since 2006 SWAP is supporting orphans and vulnerable children with main support from the Harber Charitable Foundation and private well-wishers. Selected orphans are supported with tuition fees, basic upkeep and school requirements and medical insurance. Referred cases are scrutinized and cost sharing is encouraged. Other desperate families are supported with medical support and business start up to become self-reliant. Counseling services and referral is done to partner organizations.
SWAP is active member of the Western Kenya Humanitarian Hub and Disater Management Commitee. During emergencies such as flood and cholera outbreak, SWAP supports visits to the affected families and provides material support to prevent outbreaks and mitigate the impact. In 2019 SWAP offered major support to the affected families in evacuation camps in Kisumu and Migori Counties with distribution of Food and Non-Food Items. SWAP’s water lab supports the Ministry of Health to do water testing of community watersources.
The initial response started during the post-election violence in 2008, whereby SWAP was supporting internally displaced and returnees with health products, material support and counseling. The main aim was to prevent diarrhea, malaria and other disease outbreaks and to mitigate the negative impact of the trauma.
The purpose of the emergency response was to provide a rapid integrated response to outbreaks to reduce morbidity and mortality, and prevent the spread of illness.
Response activities have two principal components:
- Training on rapid integrated response to outbreaks to the Ministry of Health representatives, administrative leaders, representatives of NGO’, Community Health Assistants and Community Health Volunteers
- Distribution of water treatment, storage and hygiene products and mosquito nets to the affected families as well as to health facilities
There have been several disease outbreaks such as cholera and response during flood. SWAP has received support from Harber Charitable Foundation for general support and CDC in the case of cholera respond in collaboration with the Ministry of Health.
SWAP is members of the Humanitarian Coordination Hub coordinated by UNICEF, which brings together all the partners for disaster preparedness and response as well as election preparedness.
SWAP continued to offer preventive services through promotion and social marketing of health and hygiene products together with hygiene promotion including hand washing.
Some desperate cases supported are referrals. Examples are vulnerable and desperate families who need support with medical or funeral bills, shelter, loss during theft or fire, displacement, nutritional support or business seed money. Each case is scrutinized and counselled by SWAPs community support officer and communities are involved for sustainability and cost sharing.
SWAP participates in many occasions and has exhibitions and promotion of health products during Global Hand Washing Day and World AIDS Marathon., international water day, NGO week e.t.c.
SWAP has for the sixth year organized the World AIDS Marathon bringing together runners from all walks of life. The World AIDS Marathon is held on the 1st of December. Activities include full and half marathon, relays, walk for vulnerable children, Voluntary and Counseling services, Sexually Transmitted Infections Treatment, Condom Demonstrations, Exhibitions, Safe Water Demonstrations.
Women Empowerment – Chiela Women Group
SWAP in partnership with the Ministry of Health, Procter & Gamble, Population Services Kenya and USAID/DIV had between 2014 and 2016 established 11 Jamii Centres in Ahero, Nyakwere, Awasi, Marindi, Kakamega, Kegondi, Kajulu, Sondu, Ugenya, Yala and Wagai with an aim of improving the health and development of babies, children and families in the community by increasing access to health products and information about health topics and healthy habits. Community Health Promoters were trained at these centers to become self-reliant by generating income through sales of health products while improving health.Chiela Women is a group of fish mongers in Dunga Beach. SWAP supported the investment of a fish cage and a boat for tour guiding. The aim was to make them self- reliant. Training was offered on business skills, record keeping, group dynamics, disease prevention (HIV, Malaria, Diarrhea).Further training was done on social marketing and social behavioral change communication. SWAP will continue offering mentorship and support investing in additional business ventures towards sustainability and economic empowerment of the group members. SWAP in partnership with the Ministry of Health, Procter & Gamble, Population Services Kenya and USAID/DIV had between 2014 and 2016 established 11 Jamii Centres in Ahero, Nyakwere, Awasi, Marindi, Kakamega, Kegondi, Kajulu, Sondu, Ugenya, Yala and Wagai with an aim of improving the health and development of babies, children and families in the community by increasing access to health products and information about health topics and healthy habits. Community Health Promoters were trained at these centers to become self-reliant by generating income through sales of health products while improving health.
The community health promoters are individuals drawn from HIV support groups, self-help groups and community units. They are trained on primary health care, social behavioral change communication, business skills, safe water, social marketing of health products, health promotion, record keeping and stock management.
Each center had an average of 20 Community Health Promoters who were each given household targets of at least 100 households. On weekly basis they would visit the Jamii Centers which served as a business hub and where all the health products were stored. The community could access these centers direct for health information and products.
However towards the end 2016 the USAID DIV funding to support these centers ended and we had to drastically scale down and close most of the centers due to difficulties to make them sustainable, complexity to manage them and to track all the products. Ahero SWAP Model village and Kegondi Jamii Center continued operations and Kisumu Headquarters did sales to partner organizations and individuals.
SWAP has a water lab undertaking bacteriological and full chemical water test at a cost with the aim to become sustainable. Bacteriological analysis costs KES 3,000 and full chemical analysis is KES 7,000. The lab is mostly utilized for research testing products and technologies, but also for surveillance monitoring water quality and identifying sources of contamination.
SWAP has a Parasitology lab which is mostly used for testing for parasites such as Schistosoma’s and other soil transmitted helminths for research. The lab works in collaboration with KEMRI and the Division of Vector Borne DiseasesLab.
- SWAP is a member of HENNET, the National Health NGO Network since 2009, board member for 8 years and National Board Chair from 2017-2019. HENNET stimulates linkages between the Health NGOs, FBOs, Development Partners in Health, Private Sector and the Ministry of Health. HENNET has been active in advocacy, social accountability, service delivery and advisory roles in Universal Health Coverage (UHC).
- Innovations in Health Care finalist – Annual forum in US and other events as well as updates on funding opportunities.
- Universal Health Coverage – Kisumu County – Conference chair and fund manager as well as member of the UHC Technical Working Group.
- University of Illinois – Students program and research with current 3 studies.
- CDC – Board member, research technical support and referral of other research partners.
- Maseno University – Ethics Review Committee
- KEWASNET, WASH HUB, KIWASH, Western Kenya Humanitarian Hub, CARE International
- Ministry of Health and Education and other GOK departments
- Interagency coordination committee and relevant technical working groups.
HCM – Health Communication Marketing Program
Safe Water and AIDS Project (SWAP) renewed its partnership with Population Services Kenya (PSK) and signed a 5 year sub award agreement in November 2016- 2021. The Five years Health Communication and Marketing (HCM) program targets Migori County in Western Kenya with focus of implementation being Malaria and diarrhea Prevention. The rationale behind this is that Migori County is among counties with high malaria prevalence countrywide. Implementation of the HCM project kicked off with Nyatike Sub – county as the start point.
The overall goal for the HCM project focuses on; Health of Kenyans improved through increased uptake of Reproductive Health/ Family Planning (RH/FP), HIV, Malaria products and services.
Implementation of social marketing and health communication within the health sector aims to build the sustainability of Ministry of Health (MOH) to lead, coordinate and implement initiatives.
SWAP through its established structures engages the communities through Malaria and Diarrhea Inter Personal Communication (IPC) intervention by adoption of the social behavior Change Communication (SBCC) as a strategy focused on increasing adoption and maintenance of healthy behaviors in regards to the following key health result areas namely,
1: Increased use of quality health services, products and information through Client focused demand creation activities expanded and Social marketing of health products expanded
2: Strengthened capacity of government to Lead, manage and govern Health Communications and marketing Counties leadership and management of health communications and marketing activities strengthened and Public health sector engagement and oversight.
3: Improved use of information for decision making through use of program monitoring and Formative research improved.
SWAP works with existing Community Units (CU’s) and Community Health Volunteers (CHV’s) who champion the SBCC in the households. Malaria, diarrhoea IPC program is implemented through household visits and Small group session (SGS) meetings. The trained community health volunteers contribute significantly towards the government health agenda by taking services to the local level.
Sondu Water Enterprise
In partnership with the Sondu community members, the Ministry of Health, Ministry of Water, Siemens Stiftung and Skyjuice Foundation, SWAP established the Sondu Water Enterprise which was formally launched in July 2016.A collaborative initiative between Skyjuice Foundation (Australia) and Siemens Stiftung (Germany) in partnership with SWAP. Seed funding was received from Siemens and ongoing crowd funding from Global Giving. The technology is Skyhydrant filtration of water from river SonduMiriu. TheEnterprise sells filtered water to the public. Public toilet service offered with hand washing station for demonstration. A local CBO wastrained to take over the enterprise and agreed on handing over to local CBO with probation of 3 months from January to March 2020. SWAP has continued to partner with Siemens in the monitoring and water testing of five other skyhydrant filters in Western Kenya. In partnership with the Sondu community members, the Ministry of Health, Ministry of Water, Siemens Stiftung and Skyjuice Foundation, SWAP established the Sondu Water Enterprise which was formally launched in July 2016.
The main objective of the Safe Water Enterprise, is to increase access to clean and safe drinking water and sanitation for the community. The enterprise is managed by a local water operator and is run under the supervision and guidance of SWAP.
SWAP was provided the sky-hydrant filtration unit by Sky-juice Foundation and an initial seed funding and technical support from Siemens Stiftung to launch the enterprise. A public toilet was built to serve the communities around Sondu. The service is on high demand in particular during the dry season. Water is sold to the communities at a rate of Kes 5/=.
Major improvements and ongoing operational costs have been done to the water Kiosk through the global giving funding.
SWAP still requires more support for the ongoing operations of the center, maintenance and monitoring as well as some improvements to increase pressure. Donations can be received through the global giving site.
Vivatos is a Dutch Foundation. It collaborates with SWAP with the aim to improve water and sanitation in schools. SWAP identified Miringo Primary School, a day school in rural Nyando village with poor water and sanitation infrastructure. The school lacked hand washing stations and sufficient water storage tanks. During drought this affects the over 500 school students in primary school from baby class (2 years and above) up to class eight. Lack of water results in diarrheal illness, pneumonia, skin and eye infections and absentia of school days and mortality in severe cases.
Recently the area experienced drought, which worsened the situation and put the children more at risk. The school receives limited support from the Government and further relies on parents paying school fees. However the area has many widows and orphans due to the high prevalence of HIV, who cannot afford to pay the fees. SWAP supported the school during a cholera outbreak in 2015 with water treatment and a 60 liter hand washing bucket, which was not enough to take care of the many children.
During World Water Day, 22nd of March 2017, SWAP with donations from VIVATOS was able to support the school with a water tank and 2 hand washing stations, placed next to the boys and girls toilet. The water tank will be used for rain water harvesting and will improve the hygiene standards at the school.