We often walked for hours through fields, woods, and along riverbanks just to find one household. And sometimes, by the time we arrived, the man we were supposed to interview had already left the house for work.

Between February and March 2025, the SHINE Bangladesh team travelled to Mymensingh and Barishal to conduct a baseline survey for the SHINE project.  Our plan was to cover five subdistricts each in the Barishal and Mymensingh districts. The subdistricts in Barishal are mostly river-oriented and remote, where commuting often requires crossing waterways. In contrast, the subdistricts in Mymensingh are largely industrial and host internally migrated communities. There are areas located near the international border where movement by outsiders is often restricted due to political tensions and limited transportation options. It was fulfilling work but also full of twists, turns, and lessons we didn’t expect.

According to the sampling design, we had to move every 10 households to collect data.  The distance between two homes wasn’t just a number. The maps don’t tell you how rough the roads are—or how much your legs will feel it later. Especially in Barishal’s char areas (river islands), reaching homes was a journey in itself. We walked through muddy paths and broken roads and even crossed small rivers. Sometimes, a boat was the only way forward, and we had to wait for hours to get a boat to cross the river. Other times, it was a hired motorbike ride followed by a 30- to 40-minute walk on the edge of a paddy field. Some clusters were so scattered that reaching the next household felt like trekking to a new village altogether.

Even after walking for miles to reach the households with the formed clusters at villages, one thing quickly became clear that in both districts, catching the male household head at home was not an easy task. In most cases, they would be out of their houses for work; some were nearby, others far away. It got even tougher during the harvesting season. We found ourselves going back to those homes more than once, adjusting our timing or rescheduling the interview.

Almost half of the data collection happened during the holy month of Ramadan, and that changed a lot of our daily work patterns. Many women were busy with prayers, preparing iftar, or simply didn’t feel up to talking during the day while fasting. On the other hand, in more conservative char regions, sometimes religious norms made it difficult for male data collectors to speak directly to women, which meant in those cases we had to rely more on female team members or reschedule visits, or sometimes both.

The sampling plan looks good in the office, but in real life, villages don’t always follow our spreadsheets. In some places, there just weren’t enough eligible households, so we had to move beyond the original boundary. That meant more walking, more coordination, and fewer interviews per day. And the “every 10th household” rule? In areas where homes are far apart or irregularly spaced, sticking to that “every 10th household” rule became a logistical puzzle. We had to have an instant short team meeting at field sites with the team lead and field team to make adjustments while keeping the integrity of our data quality.

In the Dhobaura subdistrict, Mymensingh, we hit a difficult situation. A recent incident of sexual violence had shaken the community where we were supposed to collect data, and the atmosphere was tense. Police patrols and local gatherings made it nearly impossible to continue fieldwork for a while. We had to be very strategic and careful during that tense time. And in border-side unions like Dokkhin Maijpara, in Dhobaura subdistrict, where cross-border unrest is common, outsiders (like us) weren’t always welcomed with open arms. Some community members were wary or suspicious, and earning trust became part of the job. Inspection by border guards was common while commuting to the targeted households.

If this fieldwork taught us anything, it is that maintaining methodological rigor while remaining flexible, both in scheduling and in mindset, is essential. In future field plans, we need to consider wider data collection windows, aligned with local routines (i.e., harvesting time, Ramadan, etc.). We should consider gender-matched field teams, especially in culturally sensitive areas like ours. Field plans should have time for community outreach ahead of data collection, to ease suspicion and build rapport, and account for terrain and travel time, not just sample size.

SHINE isn’t just about surveys. It’s about connecting with communities, listening closely, and making sure those often left out are finally counted—and heard.

Written by:

Ranjan Koiri (Senior Research Associate, BRAC JPGSPH, BRAC University),

Sukamal Chakma (Sr. Officer, Data Management, BRAC JPGSPH, BRAC University),

Md. Arfat Uddin (Sr. Officer, Data Management, BRAC JPGSPH, BRAC University)

The most common mode of travel for CHWs is by foot. While they also rely on local transports like rickshaws, vans, boats, motorbikes, and auto-rickshaws, using these vehicles often costs them valuable time and money or resources they can scarcely afford. Many of the roads they must navigate are poorly maintained, becoming muddy and nearly impassable during the rainy season. In some areas, rivers that serve as main transport routes dry out during the dry season, forcing CHWs to switch between multiple modes of transportation just to reach a single destination.

Beyond these physical and logistical barriers lies a deeper, gendered challenge. In districts where fishing is a major livelihood, a local superstition claims that carrying women on boats will reduce the day’s fish catch. Consequently, boatmen often refuse to transport female CHWs. Even when women are allowed aboard, they frequently face harassment: unfairly inflated fares, verbal intimidation, and, at times, even threats of harm.

For many CHWs, walking long distances remains the only viable option. In numerous upazilas, local transportation is either scarce or nonexistent. Carrying heavy equipment across rough terrains under the scorching sun or pouring rain is part of their daily reality. And as the day stretches on, many CHWs find themselves still providing services as night falls. Getting back home becomes a risky business, with dark, poorly maintained roads posing serious safety threats, especially for female workers traveling alone.

To cope with these persistent challenges, CHWs often take precautionary measures. They avoid certain routes known to be unsafe, even if it means walking longer distances. Sometimes, they wait for long hours just to find a safer or more convenient mode of transport. Many also request their husbands or other family members to accompany them during field visits to ensure their safety. However, all these coping mechanisms come at a personal cost: CHWs frequently have to pay for their commute out of their own pockets, adding financial strain to their already heavy burdens.

Despite these exhausting and often dangerous journeys, transportation allowances, if provided at all are minimal, leaving CHWs to shoulder the physical, emotional, and financial burdens alone.

The struggles of Bangladesh’s CHWs to reach their communities highlight the urgent need for better support systems, fair compensation, and safer transportation options. Their tireless dedication deserves not just recognition, but concrete action to ease their burden and honor their service.

Semonty Jahan, Senior Research Associate,

BRAC James P Grant School of Public Health, BRAC University

Mombasa County: USAID Stawisha Pwani collaborated with Mombasa County to develop and launch the second edition of the Mombasa Adolescents and Young People (AYP) Strategy 2024-2029. 

The Strategy aims to address adolescents’ and young people’s (10 and 24 years) health needs and to promote a healthy transition to adulthood while advocating for meaningful youth engagement in decision-making.

The event was graced by Abdallah Daleno, Chief Officer of Public Health and Disease Prevention, alongside other prominent leaders, partners, and youth representatives from across the County.

The Chief Officer commended the Strategy and urged for its successful implementation over the next five years, stressing the importance of collaborative efforts among stakeholders from various sectors to ensure the fulfilment of adolescents and young people’s needs and the protection of their rights.

The development of the Strategy was led by the Adolescent Health Technical Working Group, comprising members from the County Health Management Team, Sub-County Management Teams, partner organizations, youth representatives from Mombasa Youth Advisory Champions of Health (YACH), youth-led organizations, and civil society groups across all county wards.

Adolescents and young people aged 10 to 24 account for over 29% of the population in Mombasa County. Their health and well-being are critical to the development of the County. Evidence has demonstrated that this population also contributes significantly to new HIV infections and STIs.

The 2024-2029 Strategy builds upon its predecessor (2018-2023), incorporating measures for reporting and addressing gender-based violence affecting adolescents and young people. Additionally, it integrates evidence-based mental health interventions like MindSKILLZ within the County’s framework.

The Strategy seeks to enhance the health and well-being of AYP, considering diversities such as key populations, gender and sexual minorities, vulnerable and marginalized groups, and special populations. It envisions a healthy, empowered, and productive AYP with a mission to provide leadership and an enabling environment for implementing evidence-based health services.

USAID Stawisha Pwani project is a leading partner in the health provision in Mombasa County. The project will continue engaging with the young people in Mombasa County to champion the implementation of the Strategy.  

LVCT Health’s Vukisha95 project leadership signed a sub-grant agreement with the Health Department of Homa Bay County as part of our support and partnership in strengthening health systems to enhance HIV/AIDS and Tuberculosis prevention, care, and treatment services in the County.

The MoU was signed between Hon. Roselynne Omolloh, County Executive Committee Member for Health, Dr. Kevin Osuri, Chief Officer for Health and Dr. Michael Audo, Project Director, Vukisha95,  in the presence of Dr. Lilian Otiso, Executive Director, LVCT Health.

The agreement signifies LVCT Health’s continued contribution towards the County’s Health and HIV strategic plans to expand services at the community and facility levels and progress towards universal access to high-quality HIV prevention, care, and treatment services. The agreement further outlines the in-kind contributions provided by LVCT Health in support of HIV service delivery activities in the County.

LVCT Health supports the Human Resources for Health (HRH) employed by the County to perform duties related to HIV Prevention, Care, and Treatment of Persons Living with HIV/AIDS (PLWHA) and Voluntary Male Medical Circumcision (VMMC). These responsibilities are carried out within Comprehensive Care Centers, TB Clinics, Mother-Child Health (MCH) Clinics, Medical Laboratories, health records offices, and Key Population Drop-in Centers (DiCEs) integrated with Ministry of Health facilities.

LVCT Health’s Vukisha95 project has sub-granted the Homa Bay County Health Department to support 971 healthcare workers through the Human Resources for Health (HRH) program. This initiative aligns with the journey towards self-reliance, aiming for a seamless transition of HIV and TB services to the County. The goal is to ensure that HIV and TB management becomes County-owned, County-led, and County-funded, ultimately achieving sustainability, self-reliance, and improved health outcomes.

LVCT Health is delighted to have participated in the second Homa Bay County International Investment Conference dubbed (HOBIIC 2024) in Tom Mboya University grounds in Homa Bay County.

The investment conference showcased bankable investment opportunities and provided a platform for interaction and sharing of investment ideas that will lead to strategic partnerships. Additionally, the Homa Bay County International Investment Conference unveiled investment opportunities that are available in diverse sectors within the County and opened up the County for wealth creation. The investment conference sought increased business linkages and collaborations.

During the conference, LVCT Health’s Vukisha95 team showcased its transformative approach to utilizing Cloud technology to improve efficiency and accessibility, scalability, cost savings, integration, and collaboration within the healthcare setup.

The team also showcased optical technology, one of the economic empowerment interventions that targets Adolescent Girls and Young Women (AGYW) as part of a comprehensive HIV prevention programming that accelerates gains towards reducing economic vulnerabilities and promoting safer income options for the highly vulnerable population. 

Early this year, LVCT Health, through the USAID Stawisha Project, was honoured to host a delegation from eight USAID African countries: Zimbabwe, Cameroon, Ethiopia, Zambia, Burundi, Botswana, Mozambique and Nigeria for a learning visit on our Medically Assisted Therapy (MAT) project targeting People who inject/use drugs in Kilifi and Mombasa counties.

During their visit, the team visited the health department offices of Mombasa and Kilifi counties, as well as several MAT clinics, including MEWA, KISAUNI, Reach Out Centre in Mombasa, and Malindi MAT and Watamu MAT in Kilifi, where they had a first-hand experience on how the county governments and local implementing partners collaborate in reaching the recovering drug users.

In Kilifi County, the delegates were briefed on the strategies employed during the initial phase of preparation and induction into methadone treatment and how challenges were managed. They were oriented on the service delivery process in MAT clinics and the roles of each staff member.

The team later met with representatives from the Ministry of Health, Kenya Police, and the Judiciary to understand their contribution to the program, including best practices in initiating and strengthening Harm Reduction and MAT programs in their respective countries.

With support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the USAID Kenya, LVCT Health is working with the two counties (Mombasa and Kilifi) departments health, community-based organisations and local government agencies to support the successful implementation of MAT integrated health services delivery model and subsequently improve the quality of health and lives for People who inject drugs (PWID) through provision of tailor-made HIV and TB prevention and treatment programs and helping them recover from addiction.

This visit not only facilitated knowledge exchange but also laid the groundwork for future collaborations aimed at enhancing the delivery of quality health services within the MAT program in the target counties and beyond.

In a significant stride towards fostering a safer environment for children, the Dhibiti Project recently organised a successful Child Protection Sensitization Training for Tingángá DREAMS facilitators, mentors, and change agents. The event marked a crucial step in equipping frontline workers with the knowledge and skills necessary to ensure the well-being of children within their communities.

In collaboration with expert trainers, we developed a comprehensive curriculum covering various aspects of child protection, encompassing the identification of abuse, preventive strategies, and the legal framework surrounding child rights. 

The training sought to empower facilitators, mentors, and change agents with the requisite tools to establish safe spaces for children.

During the training, participants delved into the challenges encountered by children in their communities, gaining a deeper understanding during the training sessions. The sessions fostered open dialogue, allowing participants to exchange lived experiences, insights, and best practices in handling child protection issues. This heightened awareness is expected to lead to the establishment of more empathetic and responsive support systems for children.

Additionally, the training served as a catalyst for building a robust network of advocates dedicated to child protection. Emerging from the training, facilitators, mentors, and change agents shared a commitment to championing children’s rights and serving as proactive agents of change within their communities.

The training equipped participants with practical strategies for implementing child protection measures across diverse community settings. Through role-playing exercises and scenario-based discussions, participants honed their skills to address and prevent instances of child abuse.

Visible Results

Following the training, Tingángá DREAMS facilitators, mentors, and change agents have embraced their roles as community leaders. They now spearhead engagement initiatives, dispelling childhood protection myths and mobilising the community to safeguard every child’s well-being.

Rachael Karanja, a Child Protection Officer in Kiambu County, emphasised the importance of children’s voices, stating, “Children deserve to be heard because they can express their emotions too.” She exemplified the diverse roles that Children Protection Volunteers (CPVs) play in protecting and upholding children’s rights. Over 50 individuals were trained and sensitised on child protection strategies and laws.

The success story of the Child Protection Sensitization Training underscores LVCT Health’s steadfast commitment to nurturing empowered and resilient communities. As facilitators, mentors, and change agents continue to fulfil their roles as guardians, the Tingángá community experiences positive transformations, ensuring a brighter and safer future for its children.

Through the Determined Resilient Empowered AIDS-free Mentored and Safe (DREAMS) program, LVCT Health’s Dhibiti project works to create enabling environments for AGYW to reach their fullest potential. DREAMS layers multiple interventions critical to keep them safe from HIV and teenage pregnancy, among other health and socio-economic risks.

In a strategic move, LVCT Dhibiti Project today signed a Memorandum of Understanding (MOU) with Outspan Hospital. 

The partnership marked a pivotal moment in optimising organisational and leadership capacity for the for direct oversight and management of HIV/TB service delivery in in Nyeri County and its environs.

The MoU outlines key areas of cooperation, including but not limited to:

• Joint initiatives for community health outreach programs
• Collaborative research projects to advance medical knowledge and practices
• Sharing of expertise and resources to optimize patient care.

Representatives from the two organisations, Dr. Milton Omondi, the Project Director of LVCT Health’s Dhibiti Project, and Dr. Peter Muremi, Chief Superintendent of Outspan Hospital, participated in the signing ceremony, and underscored their commitment to working together for the betterment of the community’s well-being.

“We are excited about the possibilities that this partnership presents,” said Dr. Catherine Njigua, Programs Director, LVCT Health, adding that the new collaboration will create a more resilient and responsive healthcare ecosystem in the region.

Echoing her sentiments, Dr. Peter Muremi, Chief Superintendent of Outspan Hospital, stated,  “This collaboration resonates with our commitment to providing accessible and high-quality healthcare. Together, we can effectively address the evolving healthcare needs of our community.”

Through the Dhibiti Project, we are establishing a comprehensive HIV/TB clinical cascade to address the continuum of care, from prevention to treatment and support. It ensures the delivery of high-quality, patient-centered clinical care services that adhere to international standards and evidence-based practices.

Speaking during the ceremony, Dr.Milton Omondi, Project Director,Dhibiti Project said that the partnership will contribute significantly to the LVCT Health’s efforts in achieving the UNAIDS 2030 targets of ending the HIV epidemic.

The signing of the MOU demonstrates LVCT Health’s commitment of empowering communities by facilitating universal access to equitable integrated health services for all. It resonates with our strategic objectives in strengthening health systems and delivering equitable access to comprehensive high-quality health services for HIV, SRH, GBV, NCDs, mental health and emerging diseases.

He further noted such partnerships  will advance LVCT Health’s efforts of ensuring sustained success of HIV/TB prevention and clinical care services in the region.

LVCT Health  is funded by The US President’s Emergency Program for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) through to implement the Dhibiti Project, a five-year transitional initiative aimed at delivering comprehensive and sustainable high-quality HIV prevention, care, and treatment services across six counties in the central region.

The Biosafety Sensitization event featured a customized training program designed specifically for riders operating in Kiambu County. The Lab Technical Officer crafted the curriculum to address the unique challenges and safety considerations faced by riders in their daily activities.

Riders gained a comprehensive understanding of biosafety protocols, including the proper handling and transportation of medical specimens. The Lab Technical Officer designed a specialized curriculum tailored to the unique responsibilities and challenges faced by riders.

The training delved into the specifics of biosafety protocols, emphasizing the critical role riders play in maintaining the integrity of medical specimens during transit.

The event was characterized by an interactive learning experience, with practical demonstrations and hands-on sessions. Riders actively engaged in discussions, allowing them to internalize the importance of biosafety measures and how to implement them effectively in their day-to-day operations.

By sensitizing riders to biosafety protocols, the Dhibiti Project aims to contribute to strengthened community health delivery. Riders play a crucial role in the transportation of medical samples, and their adherence to biosafety standards enhances the integrity of the specimens and contributes to accurate and timely diagnostics.

The event served as a platform for fostering stronger partnerships between the Dhibiti Project and the rider community in Kiambu County. As a key organizer, the collaborative effort needed to ensure the success of biosafety initiatives and encouraged an ongoing dialogue between all stakeholders.

“I appreciate the Dhibiti Project for organizing this training. As riders, we now understand the critical nature of our role in maintaining the quality of medical samples. It’s not just about riding; it’s about contributing to community health.“ Echoed one participant.

In conclusion, the Riders Biosafety Sensitization event stands as a testament to LVCT Health’s Dhibiti Project’s dedication to innovation in healthcare delivery. By empowering riders with knowledge and fostering partnerships, the project paves the way for safer and more effective healthcare services in Kiambu County.

LVCT Health is supported by the U.S. Centers for Disease Control and Prevention CDC to implement the Dhibiti Project, a five-year transitional project to provide comprehensive and sustainable high-quality HIV prevention, care, and treatment services in six counties in the central region.

Earlier this year, LVCT Health celebrated 20 years since its registration as a Kenyan NGO in 2002 following the successful implementation of a PhD project to establish VCT centers in Kenya at the height of the HIV epidemic. The colourful ceremony provided an opportunity to reflect on the phenomenal growth the organization has had over the last 20 years and focus on the next 20 years.

For over 20 years, LVCT Health’s impact has gone well beyond HIV testing and counselling. Today, LVCT Health does a lot and is proud to be known as a leading organization in implementing large-scale programs integrated within county health facilities and communities. 

LVCT Health is known for ‘getting things done’ even in difficult circumstances, combining a technical support approach to building health systems at the community and facility level to reach key and vulnerable populations while working closely with the national and county governments to achieve impact. 

“We have grown from baby steps to adulthood, from having a small office in KEMRI to our owned premises. And from two to three, to over 400 and over 3,000 staff in counties we work in,” says Dr Lilian Otiso, the Executive Director of LVCT Health.

LVCT Health has had many notable successes during its journey: We have a footprint in 34 of 47 counties in Kenya and are PEPFAR lead implementing partner in 10 of these counties, where we strengthen health systems with the counties. We offer HIV treatment to over 20% of the population that is on ART in Kenya while pioneering innovative prevention interventions such as PrEP (pre-exposure prophylaxis, Dapivirine Ring, among others. We have played a significant role in shaping GBV in the country, building the capacity of health facilities to provide post-rape care services to thousands and informing policy and guidelines development and review. 

LVCT Health has recently pioneered Mental Health programs reaching adolescents, community health workers and affected community members. Our one2one digital platform, which includes an interactive website, tool-free hotline and various apps, has a reach of over 6 million adolescents and young people in Kenya and beyond.

A key facet of LVCT Health is innovations and commitment to testing new models through implementation research that informs national, regional and global policies and guidelines through its research-policy and practice cycle (Hatua Model).

A New Beginning, a New Strategy

As part of the 20-year celebrations, we launched a new strategic plan whose theme is Beyond 20! This strategic plan aims to take LVCT Health beyond the status quo to new frontiers:

1. Beyond HIV: We will leverage our expansive HIV platform to expand our scope to integrate other health priorities such as mental health, SRH, maternal and child health and health systems strengthening. These are in addition to addressing emerging global health priorities while leveraging the digital health space.
2. Beyond borders: Through partnerships, we will use our localization expertise and leadership in health services delivery to scale our services to other countries with similar health priorities.
3. Towards Sustainability: LVCT Heath currently depends on donors for 99% of its activities. This strategic plan aims to diversify donor funds and increase income through non-donor sources including private sector and social enterprises.

Beyond the 20 years’ timeline, LVCT Health will continue to:

1. Use our research, policy, and practice approach to inform and scale up our work.
2. Focus on vulnerable and marginalized populations, including adolescents, people with disabilities and key populations
3. Use our position and voice to advocate for the health rights of supported groups
4. Offer capacity development support to individuals and institutions, including sub-granting local NGOs 
5. Work with and through the government at national and county level
6. Invest in our institutional capacity, including our systems, to effectively and sustainably respond to health priorities in Kenya and beyond.

LVCT Health will remain guided by its vision to empower healthy and resilient communities and its mission to impact communities by facilitating universal access to equitable, integrated health services.

At 59 years old, Josphat, a Person Living With HIV, is not just another patient but a symbol of strength, resilience, and the impact that love and support can have to millions of people the organization has supported over the years in line with its mission and vision.

“At LVCT, I found a home, more than a home. This is my 20th year, and throughout my treatment journey, I have seen people dedicated to their work. I am grateful for the support”, says Josphat.

LVCT Health’s 20 years is a testament to the power of dedication, innovation, and collaboration in public health. From its visionary beginnings as an HIV-focused organization to its present-day comprehensive health programs, LVCT Health has demonstrated its commitment to improving lives. As the organization celebrates this momentous milestone, it does so with a sense of pride and gratitude for the countless lives transformed and saved. The next chapter in LVCT Health’s story promises to be equally inspiring as it continues to be a beacon of hope and progress in global public health.

A snapshot of LVCT Health’s 20 years Impact in Kenya and Beyond