Our direct operations in Kenya started off strong this year, with improvements across many KPIs. New pregnancy registrations rose nearly 40% from 0.8 per month in Q4 2019 to 1.1 per month in Q1 2020 against the target of 1. Similarly, U5 assessments and U5 treatments and positive diagnoses respectively increased 19% and 29% from our KPIs in Q4 2019. 

We launched a revamped impact optimization plan for Kenya in February based on our learnings from Uganda, though some elements will now be paused due to COVID-19. However, it had driven several improvements, including providing CHWs with a new incentive structure for assessments and for maintaining their in-stock levels of high-impact items. Another improvement came from increased targets, which were adjusted to better account for CHWs’ activities depending on whether they operate in malaria-endemic or non-endemic regions. 

 Our new incentive for keeping essential medicines in stock has been a key driver of improved CHW performance on treatments. We have identified CHW stockouts as a consistent barrier to providing treatments to patients; with this new incentive, CHW in-stock rates have increased by 27% from Q4 2019 to Q1 2020, which means more patients are receiving immediate, convenient treatments without needing to be referred to a facility. 

We also maintained our strong PNC performance at 84% compared to the 75% target. This is due to concerted efforts by analysts to send expected delivery date reports to branches at the beginning of every month and ensuring CHWs are proactively prioritizing the clients who need them. 

Our technical assistance (TA) test branch in Kisii County’s Bobasi sub-county encountered significant difficulties in Q1. A decline in supportive supervision was the biggest factor affecting CHW performance, with 35% of the county’s supervisors, or CHEWs, transferred out by government, and new ones introduced in March. Meanwhile, challenges with the government supply chain were compounded by the onboarding of 240 CHWs new in February—the largest yet under TA—and the county was not prepared to handle that quantity of CHW commodities. Although treatments dropped given the shortfall in commodities, CHWs capitalized on referrals, with completed referrals at 98% against a target of 80%. This trend is expected to continue as long as commodities remain insufficient or inconsistent. Finally, a Smart Health app upgrade in March meant that many CHWs did not have smartphones during this period. At this point, COVID-19 had reached Kenya and related concerns resulted in a decline in household visits. We are working to reverse this trend by lobbying for a strengthened government supply chain, petitioning for more supervisors under the Universal Health Coverage (UHC) funding released in February, and engaging in ongoing capacity building for government and CHEWs.  

Isiolo County saw improvement across many KPIs in Q1 2020, although it faced similar struggles to Bobasi with the government supply chain and competing priorities from government supervisors, particularly because of COVID-19. We are working closely with the county government to resolve this moving forward and ensure the sufficient allocation of essential commodities. U5 assessments per month increased nearly 30% from 2.8 in Q4 2019 to 3.6 in Q1 2020, against a target of 4—the highest level of assessments yet.  

U5 treatments and positive diagnoses also increased 43% from 1.4 to 2, meeting the target. The performance was below target for both U1 assessments and U1 treatments and positive diagnoses, and so we’ll increase focus moving forward on U1 activities as well as on pregnancies registered. These factors contributed to low U1 treatments in Q1 and a high rate of referrals at 97% against the target of 80%.  On-time PNC fell slightly to 40%, below the target of 75%. This is attributed to reduced supervision and delayed incentive payments, which decreases the motivation and activity level of CHWs.