Lumumba Sub County Hospital is the primary hub in Kisumu with approximately 17,000 patients enrolled in care as of 2016. Ministry of Health (MOH) staff provide clinical care, with technical support and mentorship provided by the FACES technical team. Lumumba Hospital houses not only FACES but also the MOH’s outpatient department, public health services and the Nyanza Reproductive Health Society.  Lumumba is considered a high volume site with roughly 200 clients booked every day for normal follow-ups.

Departments and Services Available
Lumumba Hospital houses social sciences, clinical, records, pharmacy, laboratory, cervical cancer screening, family planning, family testing, psychosocial support services, HIV testing services, maternal and child health services, nutrition, nursing, administration, systems and coordination. The outpatient department of the MOH also provides labor and delivery services.

The FACES HIV and TB clinics are independent of the MOH. Laboratory and pharmacy services are within the clinic and patients are usually referred for tests in the main hospital only if the services are not available, and sometimes to Kisumu County Hospital or Jaramogi Oginga Odinga Teaching and Referral Hospital. The Lumumba clinic is usually busy from Monday through Thursday. Fridays are left open for weekly staff meetings, CMEs and multi-disciplinary team meetings.

Kisumu County Hospital (KCH), which is situated in the center of Kisumu city just next to Kisumu Bus Park, is said to have been established in the year 1900 during the building of the Kenya – Uganda Railway. Initially it served as army barracks for the colonial government. Officers in the barracks went to the Hospital for treatment, and it also served all of western Kenya.

Departments and Services Available
Kisumu County Hospital encompasses internal medicine, pediatrics, surgery, obstetrics and gynecology, psychiatry and mental health, training and research, laboratory, pharmacy, dentistry, social work, nutrition and dietetics, nursing, accounts, imaging and diametrics, public health, medical engineering, mortuary services, casualty and emergency services, health records information, physiotherapy, and outpatient services.

The FACES HIV and TB clinics are independent of the main hospital. Laboratory and pharmacy services are within the clinic and patients are usually referred for tests in the main hospital only if the services are not available. Like Lumumba, KCH is a high volume site and the clinic is usually busy from Monday through Thursday. Fridays are left open for weekly staff meetings, CMEs and multi-disciplinary team meetings.

Located 40 minutes from Kisumu town by car, the facility lies in a tightly knit community, bordered by a school, residential houses and Kibos Prison. The environment is semi-rural with the existence of plenty of trees and plantations which make the weather a lot cooler than in Kisumu town.

Client Population and Clinic Flow
The Dispensary is relatively small and integrated with primary care; hence the number of patients per week is approximately 30-40. The Dispensary only has one clinical officer who also doubles up as the pharmacist, along with three nurses. Unlike in high volume sites where there are bigger structures, Kibos Dispensary has a single room for the comprehensive care clinic clients which serves as the clinical room, social sciences department and pharmacy. Once a client comes in, all the care that he or she may need is provided then and there because everyone is found in that same room.

Clinic Schedule
The mother and child health clinic and comprehensive care clinic are open daily from Monday to Friday. Mondays and Wednesdays are sample collection days. Thursdays are chest clinic days and CMEs take places on this day too.

Ahero is an agriculture town located 20 kilometers east of the county capital, Kisumu town. The Nyando River flows through central Ahero and helps irrigate its many rice fields. The native language of this town is Dholuo though most people understand Swahili and some basic English.

Located right along the Kisumu-Nairobi Highway, Ahero County Hospital is easily accessible from Kisumu. This is the biggest referral hospital for Nyando, Muhoroni and Nyakach sub-counties. Departments available include outpatient, maternity, pediatrics, male and female general wards, maternal and child health, comprehensive care clinic, physiotherapy, orthopedic care, dentistry, pharmacy, laboratory, nutrition and social sciences. The Hospital also has a theater (operating room) and provides C-section services on request. The most prevalent diseases include community-acquired pneumonia, HIV complications, pulmonary TB, malaria, diarrhea, hypertension and diabetes.

Clinic schedule
Like other FACES clinics, Mondays through Thursdays are the clinic days. Fridays are reserved for multi-disciplinary team meetings, CMEs, and general staff meetings. Mother and baby clinics are Thursdays. Adolescent clinics are every first Thursday of the month.

Located 20 minutes from Kisumu town, the hospital is situated along the Kisumu-Kericho Highway and is very easy to spot.                  

Client Population
Rabuor is considered to be a high volume site, with approximately 300 clients in care per week. The hospital also has an inpatient option with a bed capacity of 20, exclusive of the maternity ward. Laboratory and pharmacy services are integrated within the Outpatient Department.

Clinic Schedule
Every day is a normal clinic day for those who are enrolled at the patient support center, except for Fridays when there is a chest clinic and CMEs. The adolescent clinic is every first Friday of the month.

Nyakongo Dispensary is located 30 minutes away from Ahero town, in a rural area where most people speak Luo.

Client Population
Approximately 396 clients are on HAART through this clinic. The outpatient department (OPD) and the patient support center (PSC) are independent of each other. The clinic receives approximately 50 clients per week. Laboratory and pharmacy services offered by the OPD and PSC are independent of each other. The facility has a total of 1 clinical officer and 3 nurses who make up the clinical department. The clinical officer also doubles up as the laboratory technologist, this being a low-resource area.

Clinic Schedule
On Mondays there are maternal and child health clinics, also referred to as prevention of mother-to-child transmission. On Tuesdays, pediatric and adolescent clinics are provided; Wednesdays offer normal adult follow-up clinics; Thursdays are designated for chest or TB clinics; and Fridays are set aside for defaulters, stock-taking and drug receipt.

Located 40-50 minutes from Kisumu town, the facility lies in a sparsely populated area bordered by a secondary school, a village youth polytechnic, and a youth center. The environment is rural, full of trees, plantations, and large areas of empty land.  Houses can be seen in the distance.

Client Population and Clinic Flow

The dispensary is relatively small and integrated with primary care; hence the number of patients per week is approximately 190 to 220. The hospital has 5 clinical officers, 4 nurses, 2 pharmacists, and 4 lab technicians along with several support staff ranging from a hospital administrator to cooks and cleaning help. Just like in high volume sites where there are larger facilities, Nyango’ma is well built with a new building where there is an inpatient department with male and female wards and a pediatric section. The inner entrance is the outpatient department and the MCH section with a well-organized room serving as the labor ward.  There are separate rooms for ANC and PNC; each department here has its own room unlike small clinics where one room serves for all.

Clinic Schedule

The mother and child health (MCH) and comprehensive care clinics (CCC) are open from Monday to Friday.  Additionally, there is a pediatric clinic Monday through Wednesday, an adolescent clinic on Thursday, and a TB/viremia clinic on Friday. Ward rounds can be easily organized in Masogo and Muhoroni Sub County Hospitals by the clinical team.

Located 50 minutes -1 hour from Kisumu town. The facility lies in an evenly populated area where there are many residential (rental) and village houses bordered by schools as well as other smaller clinics which are located at a distance from each other. The environment is rural with trees and large farms of maize and sugarcane. The economic activity in this area is farming with a few women doing small-scale businesses. The weather is generally warm and wet with black cotton soil (a black muddy or clay soil in which sugar cane grows).

Client Population and Clinic Flow

The dispensary is relatively small and integrated with primary care; hence the number of patients per week is approximately 100 to 200. The hospital has a number of clinical officers and nurses, employed both by the government and by FACES and the Ministry of Health. Other staff include a pharmacist, laboratory technicians, identification and retention assistants, a hospital administrator, cooks, and cleaning help. Just like in high volume sites, Masogo is well-built including a new building where there is an inpatient department with male and female wards as well as a pediatric section. The FACES adolescent-friendly center and child playground add to the beauty of the hospital facility. The entrance is the outpatient department and the MCH section with a well-organized room serving as the labor ward, antenatal clinic and prenatal clinic. Each department has a separate room, unlike small clinics where one room serves for all.

Clinic Schedule

The mother and child health (MCH) clinic and comprehensive care clinic (CCC) are open from Monday to Friday.  Additionally, there is a pediatric clinic from Monday through Wednesday, an adolescent clinic on Thursday, and a TB/viremia clinic on Friday. Ward rounds can be easily organized in Masogo, and/or at Muhoroni Sub County Hospital (the referral hospital for the three sub county hospitals) by the clinical team.

Located 80 kilometers from Kisumu. The facility was built within the sugar estates near the factory, so most of the families in the area are sugar planters. The facility lies in an evenly populated suburb where there are many homes bordered by schools as well as other smaller clinics located at a distance from each other. There are plenty of trees and large maize and sugarcane farms. The economic activity in this area is farming with a few women doing small-scale businesses. The weather is generally warm and wet with black cotton soil (a black muddy or clay soil in which sugar cane grows).

Client Population and Clinic Flow

The patient flow at the dispensary is relatively heavy and integrated with primary care. As of March 2018, there were 1290 active clients including 53 adolescents and 45 pediatric clients. The hospital has a good number of clinical officers and nurses, employed both by the government by FACES and the Ministry of Health (FACES/MOH). Other staff include a pharmacist, laboratory technicians, identification and retention assistants, peer educators, mentor mothers, a hospital administrator, cooks, and cleaning help. Muhoroni is well-built though the facility looks old; it is well-maintained with new structures like the adolescent and TB clinics. The FACES adolescent-friendly center and child playground add to the beauty of the hospital facility. There is also a “container house” (house made out of an old shipping container) which is yet to be launched for TB near the CCC container. The main building within the facility where the outpatient department, MCH, ANC and PNC are located is older but is clean and well-organized with the inpatient department located at the entrance. There are also offices for the hospital administrator, the hospital superintendent, and the MOH team, among others. 

Clinic Schedule

Each day of the week has different types of clinics.  The mother and child health (MCH) and comprehensive care clinics (CCC) are open daily from Monday through Friday.  Additionally, on Wednesday there is a TB clinic, Thursday a viremia clinic, and Friday adolescent and pediatric clinics.  There are also voluntary male medical circumcision (VMMC), PMTCT, and family planning clinics, which are held throughout the week on an as-needed basis.  Additionally, Continuous Medical Education (CME) sessions are offered on Wednesday mornings and there are case-by-case discussions and MDT (multidisciplinary team) meetings on Thursdays to discuss clients with difficult conditions or problems. Major ward rounds are done daily in the early morning and other minor rounds may be scheduled by the hospital throughout the day.