KENYA: Increased Government Ownership Drives Results

2021 marked strong performance progress in both Kisumu and Isiolo Counties, where we are supporting the government to improve the performance of CHWs and strengthen the systems in which they work.

This is thanks to government’s increased ownership of program results and support to CHWs, enabling them to get quickly deployed and more rapidly hit their milestones. We also attribute this improvement to the strengthening of our teams in both counties and the successful leveraging of Living Goods’ performance management expertise that’s helping government teams and CHWs turn around their results.

We witnessed significant improvements in U5 sick child assessments, positive diagnoses, and treatment KPIs in Kisumu, with U5 assessments 10x higher from H1 to H2 (2.5 to 25.7), and treatments and referrals increasing 5x over that same period (1.5 to 7.6). In Isiolo we saw 2x or more increases across those indicators in that same time frame. We are also working to increase phone registrations in Isiolo, at 64% by December, so that CHWs can better reach households, and fast-tracking deploying the latest version of Smart Health, which will enable data to be directly pushed into the Kenya Health Information System.

We are excited about the eCHIS rollout in Kisumu and will work to support other counties on their digitization journeys. Since the start of the pilot in 2021, we have supported the Kisumu County government to train 777 CHWs and 46 Community Health Assistant supervisors. We plan to significantly scale up our support in 2022 to support 2,000 CHWs in the county.

Despite the progress made, performance is still well below target on many indicators, partly due to CHWs having low stocks of essential commodities, given inconsistencies in the public supply chain. In 2022, we will continue efforts we’ve already begun to support county governments’ quantification processes, to help ensure CHWs are always in stock of essential medicines.

Kenya’s MoH finally approved CHWs treating U5 children with non-fast-breathing pneumonia at the community level with amoxicillin in 2021, following years of advocacy efforts by Living Goods and other development partners. In 2022, we’ll be the first organization partnering with government to roll out this support to the households CHWs serve, starting in Isiolo and subsequently Kisumu. We are updating our workflows in anticipation of that work, while government finalizes its updated iCCM policy framework and treatment protocols.

We recorded excellent performance in our Busia learning site in 2021, surpassing most targets. CHWs conducted an average of 44 U5 sick child assessments per month and 29 U5 treatments or referrals—the highest performance on record for Busia—indicators that are respectively 36% and 52% higher than in 2020. CHWs in the county are also progressively reaching more people, visiting an average of 106 households per month in 2021 compared to 92 last year. We have found that unique households visits drive the number of child health assessments and treatments—a learning successfully picked up by our Kisumu implementation support site.

Although we were challenged by stockouts of mRDTs and some other medicines towards the end of the year in Busia, we moved quickly to restore supplies in December. In response, we are making quarterly bulk procurements in 2022 to hedge against this challenge and ensure short-term supplier shortages don’t affect CHW stock levels going forward.

The continued rollout of family planning services—done without Sayana Press in Kenya—was another achievement this year, and we rolled it out to all but four branches in Busia. We’ll fully scale up family planning across the learning site in 2022 by training an additional 530 CHWs. In September, we successfully led a COVID-19 vaccination drive with a workflow built on learnings from our childhood immunization work that enabled 81% of households’ vaccination status to be verified by YE 2021. We plan to expand this effort across our operations by the end of 2022, with a focus on pregnant women and other priority groups.

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