ACHAP Afya is a three-year USAID funded project that began in July 2020 and will run until July 2023.

The overall goal of the project is to reduce maternal and child morbidity and mortality in Kilifi County by improving the quality of health service delivery for family planning (FP), maternal, newborn, and child health (MNCH), nutrition, water, sanitation, and hygiene (WASH) at community level and primary health care facilities.

The project is adopting and scaling up evidence-based community health interventions in priority sub-counties to confront and overcome local MNCH and FP challenges, strengthening the capacity of communities and local organizations to implement and oversee these interventions. It also uses evidence-based social and behavior change (SBC) interventions at community level.

Project objective
To expand use of evidence-based high impact community health services to improve health seeking behavior and demand for these services in order to reduce maternal and child morbidity and mortality.

Geographical coverage
ACHAP AFYA project is implemented in five sub counties of Kilifi County, namely, Ganze, Rabai, Kaloleni, Magarini and Kilifi South. The project supports 68 link health facilities (FBO and county) and 52 community health units.  

Activities

A. Expanding evidence-based high impact community health services to improve health seeking behavior and demand for these services
1. Strengthen capacity of CHAs, CHWs/vHTs to deliver high impact community interventions
The project supports capacity building of Community Health Volunteers (CHVs), Community Health Assistants (CHAs) and health care workers (HCWS) in targeted primary healthcare facilities. The health workers are trained on high impact community interventions for FP/RH, MNCAH, nutrition, and WASH.

2. Provide high quality, high impact community interventions
The project supports CHVs to conduct monthly household visits on all thematic areas (FP/MNCAH /Nutrition/SBC /Wash) to targeted populations in 53 project supported CHUs.

The CHVs have identified and referred pregnant women for early initiation of ANC visits and sensitized them on hospital delivery. Postnatal mothers and newborns are visited within 48 hours of delivery and subsequently referred for PNC and CWC.

 The CHVs have been trained as Community Based Distributors (CBD) for FP, enabling them to conduct FP counseling, provide short term methods and refer clients for further services at link primary facilities.

In addition, the CHVs conduct nutritional assessments (Mid-Upper Arm Circumference or MUAC), counseling and referrals for children under two years who are malnourised. The CHVs use their SBC knowledge and skills to educate and elicit behaviour change among community members.

3. Defaulter tracing for immunization, Vit A and growth monitoring
The CHVs conduct monthly defaulter tracing for immunization and other FP/MNCAH/nutrition services. Line listing of defaulters is done by facility and community CHEWs.

4. Strengthening health facility-community linkage through CHV desks
The project has set up CHV desks in health facilities to improve linkage with Community Health Units (CHUs). The CHV desk is an open space with a desk and a chair, directory, duty roster, referral file and black book for line listing defaulters.

Facility and community CHEWs/CHAs support CHUs and work together to trace and link defaulters to services and strengthen documentation to ensure complete referrals and data accuracy. In addition, the CHVs provide health education and counseling to clients through the CHV desk and perform other task shifting activities.

5. Supporting defaulter tracing through CHAK MPower app
Project staff, 20 CHVs and four SCHMT have been trained on the CHAK Mpower application which will be used for mapping of pregnant women and newborns.

6. Supportive supervision
Monthly supportive supervision for CHVs has improved CHAs-CHVs interpersonal relationships. The CHVs feel motivated by sharing experiences, challenges and joint problem solving with their supervisors. Mentorship and OJT is provided to CHVs on areas of identified knowledge and skills gaps.

7.  Community Maternal and Perinatal Death Surveillance and Response (MPDSR) committees
A total of 32 community MPDSR committees have been formed in four out of the five project supported sub counties. In 2021, The project supported five verbal autopsies (one maternal and four perinatal) and community feedback through dialogue days.

Tracking of action plans developed through monthly community MPDSR committee meetings has led to mapping of TBAs and reorienting them to operate as referral agents and birth companions.

8. Community quality improvement coaches
CHAs and SCHMTs have been trained as community quality improvement coaches in order to improve data use for decision making at level one. CUs functionality assessment and facility WASH assessment have also been done.

B. Adopting and scaling up community health global best practices and standards in FP/MNCAH/Nutrition/WASH

1. Learning agenda
The project has adopted and implemented the knowledge and learning agenda mechanism.

2. TWG meetings
ACHAP AFYA supports and participates in county TWG meetings. The following documents have been reviewed and new versions are under development.

• County RMNCAH framework
• County FP CIP
• County nutrition plan of action

3. Social Behavior Change (SBC) interventions
Community group engagement (CGE) is recognized as a high-impact practice in attainment of FP and other MNCAH outcomes. It is aimed at fostering community ownership, self-determination, and sustainability of maternal and child wellbeing.

The project has supported communities in the implementation zones to carry out root cause analysis on FP/MNCAH/nutrition/WASH gaps, set priorities and participate in developing solutions.

This was achieved through proven participatory CGE approaches as such as community health dialogues and action days, health facility open days, peer support group meetings and mass media participation.

4. Community health dialogue days
Two key successes have been recorded as a result of community dialogue days. There was reduction of home deliveries within Kanyumbuni CHU in Rabai sub county from the previous eight to between zero and two.

Disbursement of Linda Mama funds to Kinarani Dispensary linked to Mtsengo CHU in Kaloleni Sub County increased due to the improved number of ANC clients and skilled birth attendance. As a result, the facility was able to offer locum and subsequently provide 24/7 SBA services.

5. Facility open days
Peer support groups for pregnant and lactating mothers have been formed during these days, facility and CHU performance and emerging health and adolescent SRH issues discussed. The meetings are held quarterly. 

6. Mama and Binti groups
The “Mama” groups are for women above 24 years while “Binti” groups are for those below 24 years. The groups provide forums for giving health education and promotion messages. The mothers share experiences, challenges and are supported to develop solutions.

7. Use of mass media
Through radio spots and interviews aired by local stations, messages on FP, ANC, teenage pregnancy, immunization, breastfeeding, SGBV and WASH are passed on to the project target population. The mass media programmes are done in collaboration with CHMT, SCHMT, male champions, religious leaders and FP users in the county.

8. Advocacy on community health services
Advocacy has been done with the Kilifi County CHMT to discuss strengthening CHVs as community-based distributors (CBD) for FP. A total of 1,012 CHVs have been trained as FP CBDs and referral forms printed and distributed.    

Monitoring, evaluation and learning

1. Community Based Health Information Systems (CBHIS)
The following CBHIS forms have been printed and distributed to help in strengthening data quality and reporting rates: MOH 513, MOH 514 and MOH 100. The CHUs’ reporting rates range from 80-100 per cent. In addition, the project has supported household mapping in Kaloleni, Rabai and Ganze.

2. Performance review meetings
Monthly performance review meetings are held for all the 53 CHUs supported by the project and facilitated by the CHAs and CHEWs. Discussions centre around CHU and facility data. The CHVs are given feedback on their performance and supported to develop monthly action plans. Mentorship is also done on identified knowledge and skills gaps. The meetings help strengthen facility-CHU linkage through improving interpersonal relationships between the two teams.

3. Routine RDQA
Monthly verification and validation of data is done to ensure concordance between MOH 514 (CHV service delivery log), MOH 515 (CHAs monthly summary and project monthly data collection tool). Data quality and KHIS reporting rates have improved. 

Health systems strengthening

Joint supportive supervision with SCHMT
The quality of FP/RMNCAH /nutrition/ wash services at facility and community level are assessed, as are status of equipment and commodities during these quarterly visits.