In Kisumu, newly retrained CHW Jane Ouko counsels Petronila Atieno as she nears her due date, to ensure a safe delivery at a health facility.

The county government of Kisumu and Living Goods have begun implementing a long-planned co-financed partnership that was temporarily suspended in Q1 due to COVID-19. The four-year partnership will enhance health service delivery for the county’s more than 1.2 million residents by empowering nearly 3,000 CHWs with training, equipment and digital mHealth technology and strengthening the entire community health system.

Kisumu is part of a journey where Living Goods is increasingly moving away from direct operations towards advisory models that truly prepare government to sustainably manage their own health system through co-financed or contracted technical assistance partnerships. This is critical, as Kenya’s positive trajectory into a Low- and Middle-Income Country means many donors are actively developing exit plans and expect the government to sustainably finance its own health sector needs going forward.

We kicked of implementation in September, with Living Goods equipping, preparing and financing 20 MOH trainers to partner with us to onboard new CHWs. The first cohort of 200 CHWs completed their training in October and have begun registering households with the Smart Health app. We plan to train at least 100 additional CHWs by the end of November.

In the intervening months since the official partnership was paused, Living Goods continued to support the county with its COVID-19 response—including PPE, handwashing stations and IEC materials—developing the county’s community health bill, and supporting discussions to secure the project funds for a special purpose account. This not only helped reignite momentum to implement the project, but also provided an opportunity to amend some elements of the original agreement. In addition to adjusting timelines to account for lost time, the partnership was rescoped to support all CHWs in the county, instead of an initial 1,000 CHWs in three of seven sub-counties.  The amended agreement has been finalized by both sides and will be officially signed at a widely publicized media event happening in November.

Under the agreement, Kisumu county will fund 75% of the project cost over the course of the project and will facilitate the development of supportive policies, systems and human resources to manage it. This will include leading the development of the county’s community health bill, managing the supply of essential medicines CHWs prescribe, and compensating them. Living Goods will complement government efforts by bearing 25% of the total project cost, supporting training, equipping CHWs and supervisors with digital tools, and providing technical assistance to support supervisors in data-driven performance management of the workforce.

Through this partnership, the Kisumu county government hopes to transform health outcomes and reverse the high disease burden in the malaria–endemic region, which is marked by high infant and maternal morbidity and mortality rates. Alongside Isiolo county, Kisumu will be a demonstration site about how best to digitize CHW systems into DHIS2 and will help the county resolve longstanding community health system challenges in the areas of financing, data and reporting, supply chains, and human resource management.

The partnership is Living Goods’ second co–financed partnership with a Kenyan UHC pilot county following Isiolo.  However, Kisumu’s context is much different—it has better connectivity, infrastructure, human resource capacity, and more functional health system structures.