Kisumu: Progress as CHWs Slightly Improve Performance

Community Health Worker (CHW) performance is below target but slowly improving in our scaled implementation support site, driven by continuous coaching and mentorship of CHWs, refresher training, revamped data-driven supervision and improvements in the supply chain. We are optimistic about Q2 improvements after the rollout of an impact optimization plan, although we realize these may yet take some time.

At the county’s request, we tripled the number of DESC-supported (digitally enabled, equipped, supervised and compensated) CHWs last year. Rapidly training such large cohorts meant the quality of CHW support was not up to our standard, so it is now taking us longer to ensure quality delivery. This is a lesson learned for our new implementation support site of Vihiga. We have now completed scaling to all CHWs in the county, except for 465 who are part of an evaluation study and scheduled for onboarding in Q3. Meanwhile, we continue
to be enthusiastic about the excellent ownership exhibited by the county governor
and his team.

Our efforts to improve the erratic commodity supply included engaging health facilities to appreciate the value of CHWs and share commodities with them; there is now much more collaboration, and CHWs are better equipped. We also formulated commodity management standard operating procedures and supported quantification processes.

We further worked to address quality of care gaps by training community health assistants (CHAs)—or government supervisors—before CHWs and by improving the quality of training.
There was a slight upward trend in the rate of on-time postnatal care visits and in sick child treatments, although these remained below target. We aim to fix the challenges in our workflows that cause a quality of- care gap in family planning by the end of this year.

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