While there is great promise in extending and enhancing key health services in Isiolo County, it is a new and challenging environment on a variety of fronts. Our teams are still learning how best to adapt and respond to the realities of working in a region with extremely poor network connections to support largely nomadic families who are dispersed across a vast geography. For example, CHWs must walk extensive distances to linked health facilities to get their supply of government-issued medications that communities can access for free, and typically cannot verify first by phone to ensure someone will be home before walking what can be a several kilometer distance between households. Poor network connections and vast distances also create challenges on the supervision front, in terms of syncing data, getting in touch with colleagues quickly, and figuring out the right ratio of how many CHWs each supervisor should manage.