In Q1, our directly managed operations in Kenya had their highest performance ever, with record achievements across several indicators. For example, CHWs provided an average of 21 child treatments or referrals for U5s per month in Q1—50% above the target. Supportive supervision has also been very strong, which in turn has driven a high rate of active CHWs.

A series of digital improvements helped drive this strong performance. We replaced CHWs’ faulty phones and created a new dashboard app that helped simplify their ability to visualize the data they see. Moreover, a campaign to verify client phone numbers enabled us to increase correct contact information from 60% last August to 87% by March. Ensuring CHWs can better communicate with and follow-up with households by phone drives improved access to care on-call and has enabled distanced health assessments during COVID.

Health facility deliveries and completed facility referrals were both above target, despite a health worker strike from December to February that caused facilities to be largely non-operational. Registered pregnancies were below target, but increased in March following a deliberate drive to identify all pregnant women in CHWs’ communities.

An average of 93% of under-immunized children got all necessary vaccines in Q1, against the target of 65%. There were also a record number of active CHWs trained in FP by March, leading to the program’s highest-ever monthly totals of couple-years protection and unwanted pregnancies averted. This year, we’ll scale FP from three test branches in Kisii and Kakamega counties to all six branches in Busia county. This is an exciting testament to CHWs’ success in providing FP and an important milestone given the significant unmet need in the country—18.6% among married women—with FP uptake leading to women’s improved health and wellbeing and wider socioeconomic benefits.

In our new co-financed demonstration program in Kisumu County—which is also in the prototyping phase—we recruited, onboarded, and deployed 12 county-based Living Goods staff in Q1 who will be working closely with local health teams to support implementation. In addition to providing refresher trainings for the nearly 400 CHWs trained in 2020, we onboarded and equipped a new cohort of nearly 200 CHWs in Q1, which enabled them to digitally register 54,555 households. Performance is currently below target, but is steadily climbing since the launch of health activities in January. A key impediment for CHWs in Q1 was having insufficient essential commodities—as these drive their ability to provide treatments. They will soon receive what they need from the county now that government has agreed that children between 2 months and 1-year-old can be treated for malaria at the community level.

Living Goods is working closely with the county government to ensure CHWs receive their stipends on a timely basis. We are also encouraged by a government drive to improve supervision and provided them with access to dashboard data that is being used to develop workplans and conduct data review meetings.

Our co-financed demonstration program in Isiolo county remained largely below target in Q1, and we are continuing to move forward an impact optimization plan to resolve the top barriers. This has included managing some transitions in county leadership, streamlining the utilization of digital tools to enhance performance management, and redefining the role of Living Goods supervisors as government takes on more ownership of day-to-day supervision efforts. CHWs continue to face challenges with the delayed payment of stipends by government, which affects morale and activity rates, and with accessing commodities from the health facilities, which limits their treatments. The greatest areas for improvement are assessments, treatments or referrals, and the rate of on-time PNC visits. A performance highlight was facility-related activities, with facility referrals reaching 94% in Q1 against the target of 80%, and facility deliveries hitting 82% against the target of 85%. In addition, we held capacity building sessions to sensitize government supervisors to better utilize dashboards. This has had notable results, with 75% of government supervisors accessing the dashboard in March, compared to about 35% in January.