Kenya Direct: Assessments of children under 5 (U5) continued to increase in Q2, reaching 35.6 against the target of 26, while U5 positive diagnoses per CHW were at their highest levels since inception—21.5 against the target of 14. We attribute this to a record high of active CHWs, with 72% fully stocked with essential medicines, and 97% of CHWs with functional phones and access to the Smart Health app. This improved their reporting and facilitated monitoring referral completion with health facilities, which surpassed the 80% target. Following workflow integration and routine monitoring, we also recorded an all-time high of 99% of children completing necessary immunizations in June.

The number of pregnancies CHWs registered each month, facility deliveries and on-time postnatal care visits (PNC) were all above target, due to strengthened supportive supervision, an improvement in CHW and facility links, and health facilities resuming service delivery.

In June, we trained 347 CHWs and scaled family planning (FP) services to two branches in Busia county, who will work to expand access to FP at the community level. Couple years of protection (CYP) per trained CHW dropped slightly this quarter, with fewer initial FP visits made to new women of reproductive age—the main driver for CYP. There was also a slight reduction in FP visits per month to  14.2, though this remains above the target of 12. We have since established measures to boost FP performance in Q3 by intensifying capacity building and ensuring continuous coaching and close monitoring of CHWs.

Isiolo: We continue to face challenges operating in Isiolo county, and performance was largely below target in Q2. Government has yet to pay CHWs incentives this year and there has also been a lack of consistent commodities, which are affecting CHW motivation. Consequently, CHWs performed below target on pregnancies, child assessments, and positive diagnoses or treatments.

A highlight of the quarter was immunization, with 73% of children completing necessary immunizations against the target of 65%. Health facility deliveries were also high at 88%. Given the lack of consistent medicines and current inability to treat for pneumonia at the community level, CHWs have been capitalizing on referrals; consequently, completed facility referrals were very high, at 97%. 

We are hopeful that iCCM indicators will improve with the upcoming ability to treat pneumonia with amoxycillin. Meanwhile, given increasing COVID-19 cases in the county, a top priority is encouraging vaccination.

Kisumu: We’ve seen a steady upward trend in performance since the program’s inception in January, though iCCM indicators are still well below target. Improvements have come from continuous capacity building of Ministry of Health (MoH) teams and monthly data review meetings, as well as CHWs newly equipped with essential malaria commodities.  CHWs are still being coached on providing malaria treatments—a new area for them—so we expect further improvements in the coming months.

Maternal health and immunization indicators have been particularly high and are surpassing targets. Key enablers driving this performance are strong rates of supportive supervision and close collaboration with government stakeholders, as well as consistent dashboard usage by supervisors.

We are optimistic about the increasing leadership and involvement from the county and expect to see improved results in Q3. A key learning from this work is that it takes time to align government teams, but their ownership is critical to driving performance.

As the site of the eCHIS pilot beginning in Q3, Kisumu is the focus of national attention, and recently dealt with a surge in COVID infections.