IMPLEMENTATION SUPPORT: We are excited to see performance improvements in Q3 in both Kisumu and Isiolo counties—our two Kenyan sites of government-led, co-financed implementation support. This represents a promising proof point on our journey to support governments in establishing operational best practices.

In September, we saw record-high performance in both counties for under-five (U5) sick child assessments, positive diagnoses, and treatments, in addition to improvements in data quality. We attribute this success to our closer partnership and continued collaboration with county leadership to understand and drive performance on a weekly basis. We are excited about the increased engagement by government supervisors—known as community health assistants (CHAs)—to motivate community health workers (CHWs). Specific steps included adding new peer coaches to mentor CHAs on performance management and holding regular data review meetings.

Even though there was a slight improvement in stocks of essential commodities—a major driver of treatments—inconsistencies in the public supply chain persist, and often affect performance. As such, we have started supporting the county governments’ quantification processes to ensure CHWs are always in stock of essential medicines. We also continue to advocate for timely quarterly payments to CHWs by government, as persistent delays affect morale.

While it is good to see Isiolo’s improved assessments and treatments, performance in the county remains significantly below target.

The rollout of the updated Supervisor App in both Isiolo and Kisumu in the coming months is expected to drive post-natal care (PNC) performance, among other indicators, as it enables supervisors to see CHWs’ tasks and encourages them to improve the timeliness of these visits. We will also resume training CHAs to boost supervision and focus on increasing the number of household visits, which is linked to higher rates of health activities.

BUSIA LEARNING SITE: Busia County remains our only learning site in Kenya and continues to see strong performance. In Q3, we achieved above-target performance for sick child assessments and treatments for the 5^th consecutive quarter. These results have been driven by free medicines, the revised compensation structure we established for CHWs during COVID-19 to keep them motivated, supportive supervision—which was at 100% throughout the quarter—and strong digital capabilities.

Two promising areas include the launch of a family planning (FP) pilot in Busia, with 324 CHWs trained, and the initiation of an experiment to treat possible serious bacterial infections among newborns that involves 336 CHWs.

THE CHANGING COVID-19 CONTEXT: CHWs in all counties continued to educate households on COVID-19 and screen for symptoms, even though infection rates have gone down. With the Kenyan Ministry of Health (MoH) reporting that only 6.7% of the national population was fully vaccinated by the first week of November, CHWs still need support to sustain community sensitization and drive uptake, especially now that vaccines are more available. Our newly deployed COVID-19 vaccine support workflow in Busia will help check completed referrals and track household vaccinations, building on the success of our approach to childhood vaccination tracking. Nearly two-thirds (1,311) of the CHWs we support in Kenya have received at least one dose of the COVID-19 vaccine; this includes 88% of CHWs in Busia County, 92% in Kisumu, and 8% in Isiolo.