How Kisumu has transformed maternal, child healthcare in two years

On a sunny Wednesday afternoon, Monica Awino, a Community Health Promoter (CHP) in Kisumu County, is on her way to Celine Achieng’s homestead. 

Celine, who is in her late 50’s, is a caregiver of two-and-a-half-year-old Ray Onyango, who has had fever in the last two days.

Monica will conduct a routine check-up on the baby  as she has done since the beginning of her community health work in 2019.

She will also note the family's history of non-communicable diseases and the general household sanitation.

Using a smartphone, she swipes through various work flows before reaching Ray's records. She examines his immunisation record guided by an application on her phone, and it shows that he is up to date with the childhood vaccination schedule.

"I will also inquire about how the child has been fed for the last 24 hours and if he has any signs of diarrhoea," says Monica.

After collecting the child’s health history, Monica reveals that Ray has had high temperatures over the last two days.

While his temperature is back to normal, the CHP insists that the baby should take a malaria test. She puts on gloves and after cleaning Ray’s fingertip with cotton wool and spirit, she pricks the finger to get blood samples.

While awaiting the results, Monica takes time to educate Celine about malaria. The test confirms that Ray has malaria. Luckily, the CHP is armed with malarial drugs.

A single anti-malaria tablet is mixed with water and given to the baby. Monica  notes that the next dose should be administered after six hours.

“I will be back in the next 24 hours to check how he is responding to the medication. In case his condition deteriorates, I will issue his grandmother with an immediate referral letter to visit Masogo health facility,” says Monica.

The national government’s campaign to support CHPs has acquired traction, with President William Ruto providing support to the promoters.

Kisumu County has already piloted the scheme. In the last two years, the county has successfully digitised primary healthcare programmes to improve efficiency and efficacy.
Community health promoters have transitioned from analogue to digital reporting using electronic gadgets after gaining proficiency through technical training.

A visit to Muhoroni Sub-county reveals the progress of the digitisation process, which began in 2021. The project has resulted in decongested hospitals, fewer maternal deaths, increased immunisation uptake and improved healthcare for residents at the household level.  The CHPs’ monthly household visits have played a significant role in keeping babies’ health on track.

Celine says her visits to the hospital are now limited to routine immunisation and when the baby does not respond to treatment prescribed by the health professional.

"In the village, we tend to be forgetful but this was not the case when it came to my grandson's immunisation schedule. The community health promoter would call a day to the scheduled date to ensure that I do not miss the crucial services," says Celine.

As we leave Celine’s compound, the community health promoter informs us that she has data for every resident in the area.

The data, she notes, aids in tracking vaccine defaulters, cases of malnutrition, skilled deliveries as well as locating non-communicable disease patients who fail to take their medication. "My phone always gives me a reminder whenever the persons listed above need to visit a health facility, so all I do is follow up," she says. Unlike in the past when she had to carry three large books for household data records, the phone has made work easier.

After each household visit, the new development she has recorded is synchronised to a central database, a dashboard that can be assessed by county health professionals.

The CHP also records details of every expectant mother in the area including her next antenatal care  visit, expected due date, any underlying health condition and history of past pregnancies. The details, she says, helps in tracking down women who default antenatal clinics, identifying  pregnancy danger signs while also ensuring that every newborn is delivered in a health facility.

Maureen Opiyo, Kisumu's CHP coordinator, says the county's digitisation journey began in 2020 with the development of a smart health mobile application for household service delivery. "This is what informed piloting of an Electronic Community Health Information System ) in 2022. We started with Muhoroni and Nyakach sub-counties.”

The county partnered with Living Goods, an NGO, to provide community health volunteers with smart phones worth Sh45 million. The county was to facilitate 70 per cent of the work while the organisation was to handle the remaining 30 per cent.

The CHPs underwent training on how to utilise the smart health app for home registration, patient screening, hospital referrals, malaria and diarrhoea management.

Health Executive Gregory Ganda says in the last two years, they have witnessed an increase in hospital deliveries. Before the programme was launched in 2019, facility delivery per sub-county ranged between 64 to 69 per cent. “The number now ranges between 92 per cent to 96 per cent per sub-county.” 

According to the latest statistics from the Health department, Kisumu has managed to reduce maternal mortality by 30 per cent from 495 to 343 per 100,000 live births.

Dr Ganda says: “Maternal mortalities have decreased by 30 per cent due to increased skilled deliveries.”

Child mortality has also reduced from 54 to 39 per 100,000 live births .

The official adds that the mortality rate among the under-fives has reduced from 79 to 63 deaths per 1,000 live births .

Meanwhile, the number of household visits by CHPs also improved from 187,977 in 2022 to 206, 420 in 2023.

The county is now planning to start digitising its health facilities in four wards per year.

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