In Kenya, our direct operations performance improved on nearly all metrics in Q2, despite mounting COVID-19 infections in the country and challenges traveling during the quarter. We had a record high in U5 sick child assessments and June marked one of our highest-ever on-time PNC rates. Average monthly U5 assessments per CHW increased from 20 in Q1 to 22.6 in Q2, driven in part by the new CHW incentive structure. Meanwhile, monthly U5 positive diagnoses and treatments per CHW also increased from 8.0 to 8.7, due to the focus on CHWs being in-stock of essential commodities—though these are still not at target.

Many of our program adjustments in Kenya were not rolled out until early June.  Given the complexity of working within Kenya’s devolved health system, we needed to align with each county on new protocols, and create more than one new workflow for the app.  The Kenyan MOH also pushed back on doing presumptive malaria treatments, as we were doing in Uganda, and some counties wanted CHWs to continue household visits. This required us to procure additional PPE, which took some time. We expect with the fully adjusted program there will be an even greater number of treatments; we already began seeing increases in the second half of June. The percent of on-time PNC visits reached 86% in Q2, surpassing the target of 75%; we attribute this continued improvement in part to the timely sharing of expected delivery date reports so that CHWs can follow up with women about to give birth. FP visits per month fell from 9.2 to 7.8, due to an MOH directive to halt community distribution of Sayana Press, which we had been testing. We gave our remaining stock of the injectable to health facilities and focused on making referrals so that we could ensure women could still access it. This is really paying off, as the results have been quite strong; we also saw an increase in the number of women who took up an FP method during the quarter. Living Goods’ focus on continued provision of essential services during COVID-19 is also reflected by our immunization improvement: the percent of defaulters completing necessary immunizations increased in Q2 from 76% to 81%.

In our technical assistance (TA) efforts Bobasi sub-county, average assessments and positive diagnoses/treatments per CHW declined from Q1 to Q2, but there was strong improvement through May and June. Pregnancies registered per CHW also improved from 0.7 in Q1 to 1 in Q2, meeting the target. Notably, the percent of assessments that are positively diagnosed is at an all-time-high—rising from 49% in Q1 to 59% in Q2. We attribute the dip in performance at the beginning of the quarter in part to the introduction of a new cohort of CHWs in February who took time to get up–to–speed. Assessments and treatments were also affected in Q1 by difficulties around government supervision and provision of commodities, which we don’t directly control in Bobasi. These issues were resolved in Q2, and the team coached MOH supervisors to better support inactive CHWs remotely, causing more CHWs to become active in the second half of the quarter. In fact, Bobasi reported the highest supervision rates across all our areas of operation in May and had the highest household visit rate in Q2 among our areas of operation, at 83.5 per CHW.

Our co-financed program in Isiolo County saw small declines in assessments, treatments, and pregnancies registered per CHW in Q2 and relatively stable performance elsewhere. Isiolo was one of the first counties to report COVID-19 cases, and its remote geography and poor technology infrastructure make remote assessments and supervision more challenging.  Both CHWs and government supervisors faced competing priorities as they were pulled into the COVID-19 response. The remote workflows were not adopted until June—which also affected supervision—as supervisors were not immediately available to conduct trainings when the workflows were ready for deployment.  However, by the end of Q2, Isiolo recorded its highest supervision rates in 7 months. The county does not allow CHWs to treat pneumonia and there were limited supplies of essential commodities at the beginning of the year. But CHWs are now distributing free medicines primarily provided by the government, with only a small supplementation by Living Goods. The percent of positive diagnoses treated increased from 59% in Q1 to 66% Q2, attributed to the commodity kits distributed to CHWs by the government in April. The rate of on-time PNC also improved from 40% in Q1 to 47% in Q2.