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November 23, 2019
Following the momentous launch of the community health program, we are co-financing with Kenya’s Isiolo County government, the first 340 CHWs who graduated are now actively providing primary health services to 14,500 households throughout Isiolo, Garbatulla and Merti sub-counties. In October, we began training the remaining 380 CHWs in the county, which will bring the total number of households directly benefiting to approximately 58,000.
We facilitated a critical milestone in August when we successfully pushed community-level data from our Smart Health app into the government’s DHIS2 system. This is a key step in enabling the government’s effective independent analysis of community-level health indicators, which is essential for budgeting and operationalizing broader government-led efforts.
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.
We are also navigating how to efficiently manage operations when we do not have full ownership over all components and are working in even closer partnership with government. Of great significance is that the government is directly paying CHWs their monthly stipends. We are still working with the government to codesign the metrics for additional performance-based incentives for CHWs to supplement the stipend.
In addition, we are evaluating how to simplify our app workflow to ensure it remains robust but not so heavy, given the need to manage both government requirements and the elements proven successful for Living Goods. We are also looking at how best to develop KPIs that better capture the work we’re doing to strengthen the broader health system since these aren’t traditionally accounted for in our direct model, allowing us to effectively focus our support where it can be most impactful.
Despite these challenges in these earliest stages of project implementation, we are seeing some improvements month on month. From August to September, although household visits per CHW dropped 7%, we saw a 49% increase in on-time PNC visits and a 14% increase in U5 assessments per CHW. We are also very pleased that the government has maintained its commitment to paying its portion of the community health program. This model is attracting significant interest elsewhere in Kenya, and we are already deep in discussions with one other county about how we might provide similar support.