Our tests providing technical assistance (TA) to governments and their implementing partners showed increases in their performance in the second half of the year, although they were largely below target. Although Living Goods has less direct control over program implementation when working through partnerships, there is increased sustainability and government ownership. We are continually learning the best approaches for supporting and cascading to others our experience around Digitally enabling, Equipping, Supervising and Compensated CHWs—what Living Goods calls the DESC principles.

Supervision was a highlight across all of these efforts. Our TA experiment in Kisii county’s Bobasi subcounty—a continued learning opportunity for us—reported the highest supervision rates across all areas of operation in Kenya in May. Although Bobasi’s performance was largely below target in 2020, there were steady improvements throughout the year. In our co-financing branch in Isiolo county, the percent of CHWs receiving active monthly supervision increased from 64% in H1 to 81% in H2 after the county government recruited and trained new supervisors. An occasional challenge in both areas, meanwhile, was securing consistent commodities from the public supply chain.

In Uganda, our partner BRAC’s supervision rates also improved toward the end of the year, though it aims to strengthen this further in 2021 with the launch of the Supervisor App, recruitment of more supervision staff, and the scaleup of a peer supervision pilot. Tech challenges for BRAC highlighted the importance of the digital component of CHWs’ work: BRAC saw strong improvement at the end of the year after most CHWs’ phones were replaced in October, resolving an issue with reporting activities that had plagued much of 2020’s performance. Other performance drivers were an mHealth upgrade completed in August and monthly incentives for active CHWs that began mid-year.

Difficulties in our Isiolo co-financing program were compounded by COVID-19, given the county’s poor physical and data infrastructure. The pandemic also dominated the government’s health bandwidth and worsened a disagreement within government over revenue-sharing. As a result, county health funding was withheld for most of 2020, delaying CHWs and supervisors’ payments and lowering CHW performance. However, the impasse was resolved in November and we saw KPIs improve slightly in December. One milestone was the launch of immunization counseling and referral services despite the disruptions caused by COVID-19. We expect that with the payment situation resolved and through continued training and more timely incentives, performance will continually improve. We are also excited to support Isiolo in 2021 as the first Kenyan county to pilot CHW-distributed amoxicillin for fast-breathing pneumonia.