Eddy Ingutia

Written by Millicent Ouma, Research officer at LVCT Health

Innovation doesn’t always look like new machines or big budgets. Sometimes it looks like sitting under a tree with Traditional Birth Attendants (TBAs), mapping their locations, and having honest dialogue about antenatal care (ANC).

That’s what Work Improvement Teams (WITs) under the C-It-Du-It project (pronounced “see-it-do-it”), a consortium of Lvcthealth, Liverpool, KEMRI, and the Ministry of Health, have been doing in communities across Homa Bay County. One of the many innovations WITs have used to increase ANC attendance at health facilities is mapping TBAs village by village, talking with them about why ANC visits at health facilities matter, and linking expectant mothers to Community Health Promoters (CHPs) so fewer mothers rely on TBAs alone. It is grassroots work built to close the gap the WHO warns about: too many mothers starting ANC late, and too few completing the recommended eight contacts, a gap that drives poor maternal and neonatal outcomes.

On July 28, 2026, nurses across Kenya walked out. Homa Bay’s facilities, already strained by an earlier doctors’ strike this year, went quiet again. Now in its second week nationally, the strike has left maternity wards overwhelmed and understaffed, with the Kenya Obstetrical and Gynaecological Society warning that care for pregnant mothers is deteriorating fast.

The Setback

Overnight, months of trust-building felt undone. With facilities closed, ANC mothers have nowhere to go. Many are being pushed back toward TBAs, who never go on strike and remain affordable and close.

This fear runs loud among WITs: “Imagine, so many ANC mothers who currently come to the facility have no one to attend to them. They are being turned away. We share this with the staff over phone call, but they also say their hands are tied, they cannot rescue the situation,” said one WIT chair during a WIT meeting I attended.

We understand why ANC mothers would prefer the TBAs. Transport to the facilities costs money. Waiting costs time. Even, when mothers sacrifice their meagre income and time to make the journey, the strike stands as a stumbling block to the care they need, while the TBA is right there. But we also know the risks: TBAs do not perform  ANC profiles, they cannot manage complications, and every mother redirected back to them is a mother at higher risk.

Keeping the Bridge Standing While the Strike Lasts

Having already mapped and built dialogue with TBAs, the WITs and CHPs are keeping home visits going, since CHPs are the first level of care. They continue identifying pregnancies at household level, checking and counselling ANC mothers and pregnant adolescent girls, tracking due dates and birth plans, and teaching danger signs. The mapped TBAs continue to serve as first-contact and referral points, flagging emergencies immediately. The CHPs have been carrying a simple message to mothers: the facility is closed, but you are not alone, see your CHP, and return to the facility once it reopens.

Nyalkinyi WIT: CHPs_TBAs_ANC mothers meeting

The Bigger Lesson

This strike exposed three hard truths:

• Access gaps kill progress. When facilities close, communities default to whatever is available.
• Affordability matters. TBAs win because they are cheap and close.
• Community systems are the safety net. Without WITs and CHPs, these mothers would have been invisible.

The mapping work has not been wasted. It’s the reason pregnant mothers and adolescent girls can be pulled back to facilities quickly once services resume because the trust is already there.

Call to Action

• To county and national leaders: Protect community health systems during strikes by motivating CHPs. Equip them with ANC commodities like functional blood pressure machines, thermometers, colour-coded MUAC tapes, and pregnancy and malaria RDT kits to ensure effective household visitation and assessment. Fund dialogue with TBAs. Don’t let a strike erase months of community work. Resolve this dispute before more mothers pay the price.
• To mothers: Your life matters. Don’t stay silent if you feel unwell,  your CHP is still here. A strike should not force you to choose between no care and unsafe care.
• To the WITs: Continue mapping and deepening dialogue with TBAs. This ensures continued linkage of new and old ANC mothers and pregnant adolescent girls to CHPs and to health facilities. Walk with the community, even in crisis. You built the bridge before the flood. Now you must keep it from being washed away.

#MaternalHealthKenya #HCWsStrike #TBAs #ANC #HomaBay

By Marvin Odhiambo, Trial Team-Health Economics

Kenya continues to face high rates of teenage pregnancy, particularly in Homa Bay County. Many young mothers initiate antenatal care (ANC) late due to financial barriers, stigma, and long travel distances. Behind each teenage pregnancy is a girl facing not just physical changes, judgment or isolation but lack of financial support to cater for the costs associated with the pregnancy. Despite Social Health Authority’s (SHA) efforts to make ANC services free, hidden costs such as laboratory fees, registration, and transport remain out of reach for many. Without national IDs, adolescents are excluded from SHA insurance, forcing them to pay out-of-pocket and often delaying essential care.

Antenatal Care: Why It Matters

ANC is a lifeline for both mother and baby. Through regular clinic visits, health workers can monitor the pregnancy, detect problems early, and give mothers vital information on safe delivery and caring for newborns. The World Health Organization recommends at least eight ANC contacts. But in Homa Bay the C-it Du-it study found that only 1 in 40 teenage mothers in Homa Bay completed the recommended 8 ANC visits.

For Atieno, 16*, the challenge was different: “The hospital is far, and I had no money for transport. My aunt told me to wait until the pregnancy was bigger before going. I went only once before I delivered.”

Health workers also confirmed this trend. One nurse in Suba Sub- County explained: “Most of the girls come to us very late, sometimes when they are almost due. They fear being judged or simply don’t have money to pay for ANC services and transport.”Another nurse at Rachuonyo North added: “Many teenage mothers don’t have National IDs or birth certificates, so they can’t register for Social Health Insurance (SHA) to cater for ANC services. Some even start ANC early but drop out because they can’t afford the tests when requested.”

The Risks Associated with Teenage Pregnancy

Teenage girls face greater health dangers during pregnancy than older women. Their bodies are not always ready for childbirth, which increases the risk of complications like anemia, high blood pressure, obstructed labor, or heavy bleeding after delivery.

Babies born to teenage mothers are also more vulnerable, they are more likely to be born too early, too small, or to die within the first month of life.

The impact doesn’t stop at health. Many teenage mothers are forced to leave school, making it difficult to find jobs later. Stigma and rejection from families or communities add to their struggles, trapping many in cycles of poverty.

What Can Be Done?

There is hope. The C-it Du-it study revealed that lack of youth-friendly services and stigma from providers were among the key reasons for low ANC attendance; issues that can be addressed through:

• Youth-friendly health services – clinics should be safe and welcoming places where teenagers are treated with respect and confidentiality.
• Community support – parents, teachers, religious leaders, and neighbors need to reduce stigma and encourage young mothers to seek care.
• Education and mentorship – giving young people knowledge about reproductive health and linking them to mentors can help them make informed choices.
• Financial and policy support – free or subsidized ANC services, and school re-entry programs can remove barriers.
• Peer support groups – teenage mothers sharing experiences and encouraging each other can boost confidence and clinic attendance.

A Shared Responsibility

Teenage pregnancy in Homa Bay is not just a health issue. It is a community challenge that calls for everyone’s involvement. If we stand together to break stigma, support young mothers, and make sure they receive the care they need, we can save lives and give girls a second chance at education and a brighter future.

Policymakers and funders also have a vital role to play by strengthening SHA, investing in adolescent-friendly health services, and ensuring that national policies and resources reach the girls who need them most.

Because when we protect our girls, we protect our community.

Name changed to keep personal privacy and anonymity.

Story by Mourine Ooko

At just 17, Akothee* from Homa Bay began a journey no adolescent should walk alone. Her story is about teenage pregnancy and the tragic consequences of a system unprepared to serve its most vulnerable. It shows, painfully, what happens when policies meant to protect instead create barriers that can create preventable hardship and, at times, cost young mothers and their children their lives.

I met Akothee through the C-IT-DU-IT study, a maternal health research initiative by KEMRI, Lvcthealth, LSTM, and Kenya’s Ministry of Health. The study helps women access antenatal care (ANC) and encourages them to complete the recommended eight visits.

A Pregnancy That Began With Barriers

She first visited the local facility in January, seeking care for fatigue and nausea. A pregnancy test confirmed she was expecting. Being so young, she could not recall her last menstrual period, making it difficult to accurately estimate gestational age. Her first ANC visit should have included essential tests and an ultrasound, normally all covered by Kenya’s new national health insurance system, the Social Health Authority (SHA). However, SHA requires a national ID to register.

Many adolescents like Akothee lack a national ID, her mother had no insurance, and the family could not afford private tests. She left the facility without the investigations that could have guided her care. This was the first of many barriers that would shape her pregnancy.

When Poverty Meets Policy Gaps

Her mother, a single parent working as a house help to sustain eight children, could barely afford food, let alone medical fees. Because of this, Akothee could not return for follow-up visits for nearly two months, and this delay meant missing critical early screening.

She found much-needed support in a compassionate Community Health Promoter (CHP), who walked with her through each step and referred her for more advanced tests. But even with referrals, the financial gaps remained. The ultrasound fees at the referral facility were still out of reach.

Her pregnancy progressed without the investigations and access to care that many women receive without a second thought.

Delivery and Devastating News

When labour began, the situation quickly became complicated. She was referred for an emergency caesarean section at a private facility. After delivery, instead of the joy every mother hopes for, she was met with devastating news that her baby was born with a severe medical complication. It was the kind of condition that standard antenatal screening would almost certainly have detected.

I could not even comprehend what was wrong with my baby, though they talked to me and referred me to Homa Bay County Teaching and Referral Hospital for further treatment and care.

A Race Against Time

At the referral hospital, she was advised to seek specialised treatment in Eldoret. The cost of travel and care was beyond what any adolescent mother could handle and certainly beyond what Akothee’s family could ever afford.

She returned home, giving her baby the best care she could with the little she had. During one of our study team’s home visits, a staff member saw the gravity of her situation and mobilised support. Funds were raised for her SHA registration, transport to Eldoret, and some upkeep.

It felt like hope, finally, but it came too late. By the time specialists reviewed the baby, the condition had progressed too far. Curative treatment was no longer possible. She was advised to seek palliative care back home. Her baby passed away a week after discharge.

Grief and Strength in Equal Measure

Losing a child at such a young age is an unimaginable pain. Yet, Akothee, barely an adult herself, showed remarkable strength throughout her ordeal.

Yet even in her grief, Akothee remained composed, reflective, and determined that her experience should not be repeated. She has since begun speaking in her community about antenatal care and the challenges that adolescent mothers face showing great courage and resilience.

What Her Story Forced Me to Confront and What Lessons Need to be Learnt

As a young woman in my twenties, hoping one day to become a mother myself, watching her journey shook me deeply. I had to pause and re-think how fragile, yet powerful motherhood can be. I admired her courage, but I was also profoundly unsettled.

Because the truth is simple:

• Her baby did not die because she was young.
• Her baby died because the system did not give her a fair chance.

Akothee’s experience is not an exception unfortunately. Many teenage mothers in Kenya face the same obstacles: documentation requirements they cannot meet, poverty that delays or blocks care, referral systems that assume resources they do not have, and insurance schemes that remain out of reach despite promises of universality.

Her Resilience Deserves Admiration : Her Experience Demands Action

To provide true universal health coverage, adolescent mothers cannot remain invisible in policy design. There is a call for urgent reflection and reform to prevent stories like Akothee’s from repeating.

Policymakers, health leaders, and community health programs alike need to swiftly and adequately, prioritize teenage mothers and provide stronger support networks, which is all inclusive, and dismantling barriers in documentation and financial hurdles, that will create tangible support paths for young mothers.

Healthcare must transition from privilege to right. For Akothee, and those like her, her story beckons not just sympathy but transformative compassion and resolute change.

Names have been changed to protect privacy.

Story by JohnBosco Omasaja- Clinical Officer and Research Officer, KEMRI

Teenage pregnancy continues to weigh heavily on the lives of young girls in Homa Bay County, often cutting short their education and reshaping their future in unexpected ways. For many, the journey into motherhood begins without the knowledge, support, or resources they need to stay healthy.

A key challenge for most teenage mothers is accessing antenatal care (ANC). While clinic visits are essential for monitoring pregnancy, preventing complications, and preparing for safe delivery, many girls either start ANC late or miss out altogether. Fear of stigma, long distances to health facilities, and lack of financial support often stand in their way.

Behind every teenage pregnancy is a young girl navigating not just the physical changes of motherhood, but also the social and emotional weight of judgment and isolation. And when they are unable to get the right care at the right time, both their health and that of their babies are put at risk.

Antenatal Care: Why It Matters

Antenatal care (ANC) is a lifeline for both mother and baby. Through regular clinic visits, health workers can monitor the pregnancy, detect problems early, and give mothers vital information on safe delivery and caring for newborns. The World Health Organization recommends at least eight ANC contacts. But in Homa Bay, many teenage mothers do not complete all the 8 contacts as recommended, some start when the pregnancy is already advanced, and some only manage one or two visits before giving birth.

Mary, a 17-year-old*, shared her story: “I didn’t even know I was supposed to go for clinic early. By the time I went, I was already seven months. The nurse asked why I delayed, but I was afraid people would see me and laugh.”

For Atieno, 16*, the challenge was different: “The hospital is far, and I had no money for transport. My aunt told me to wait until the pregnancy was bigger before going. I went only once before I delivered.”

Health workers also confirmed this trend. One nurse in Suba Sub- County explained: “Most of the girls come to us very late, sometimes when they are almost due. They fear being judged or simply don’t have money to pay for ANC services and transport.”

Another nurse at Rachuonyo North added: “Many teenage mothers don’t have National IDs or Birth certificates, so they can’t register for Social Health Insurance to cater for ANC services. Some even start ANC early but drop out because they can’t afford the tests when requested.”

The Risks Associated with Teenage Pregnancy

Teenage girls face greater health dangers during pregnancy than older women. Their bodies are not always ready for childbirth, which increases the risk of complications like anemia, high blood pressure, obstructed labor, or heavy bleeding after delivery.

Babies born to teenage mothers are also more vulnerable, they are more likely to be born too early, too small, or to die within the first month of life.

The impact doesn’t stop at health. Many teenage mothers are forced to leave school, making it difficult to find jobs later. Stigma and rejection from families or communities add to their struggles, trapping many in cycles of poverty.

What Can Be Done?

There is hope. Teenage pregnancy is not a problem without solutions. Communities, families, schools, and health workers all have a role to play. Some of the steps that can help include:

• Youth-friendly health services – clinics should be safe and welcoming places where teenagers are treated with respect and confidentiality.
• Community support – parents, teachers, religious leaders, and neighbors need to reduce stigma and encourage young mothers to seek care.
• Education and mentorship – giving young people knowledge about reproductive health and linking them to mentors can help them make informed choices.
• Financial and policy support – free or subsidized ANC services, and school re-entry programs can remove barriers.
• Peer support groups – teenage mothers sharing experiences and encouraging each other can boost confidence and clinic attendance.

Role of C-IT DU-IT Study

To bridge these gaps, the C-it Du-it study, currently underway in Homa Bay County, is working to strengthen uptake of antenatal care among pregnant women, adolescents included. A key driver of this effort is the use of Work Improvement Teams (WITs), which bring together community health promoters, facility staff, and local leaders to review barriers to ANC, track missed or late ANC initiations, and develop practical, data-driven solutions. Through these efforts, WITs are proving to be a powerful quality improvement engine, turning insights into action and making ANC more accessible, supportive, and timely for those most at risk.

A Shared Responsibility

Teenage pregnancy in Homa Bay is not just a health issue. It is a community challenge that calls for everyone’s involvement. If we stand together to break stigma, support young mothers, and make sure they receive the care they need, we can save lives and give girls a second chance at education and a brighter future.

Because when we protect our girls, we protect our community.

Names have been changed to protect privacy.

Written by J. Jagongo- Kitare

The C-IT-DU-IT (“see it, do it”) study, a collaboration between KEMRI, LVCT Health, the Liverpool School of Tropical Medicine, and Homa Bay County Department of Health, has introduced an innovative approach to improving antenatal (ANC) uptake and outcomes. By strengthening data linkages between community health promoters (CHPs) and facility-based health care workers (HCWs) the intervention is helping pregnant women and adolescents complete the full eight ANC contacts, in line with WHO recommendations.

Linking Community and Facility Data for Action

At Kitare Health Centre, community and facility teams now share real-time information on pregnancies through an integrated data system. CHPs identify pregnancies at the household level, record ANC status and newborn immunisation data, and transmit this information to data clerks, and HCWs at the facility. This linkage allows for timely follow-up, targeted outreach, and seamless referrals for women who miss appointments or require additional support.

Impact: More Women Completing Eight ANC Contacts

Before the intervention, many women in Kitare did not complete the recommended number of ANC visits. With strengthened data integration and consistent communication between CHPS and HCWs, the proportion of women attending all eight contacts has risen significantly. The linked system has made it easier to monitor attendance, identify missed visits early, and address barriers such as transport or lack of awareness.

Improving Quality of Care

Beyond attendance, the project has improved the quality and timeliness of ANC services. Enhanced referral mechanisms ensure that pregnant women reach facilities earlier, where teams are ready to provide standardised care. Key elements included:

• Continuous availability of iron and folic acid (IFA) supplements to prevent anaemia.
• Regular provision of intermittent preventive treatment for malaria (IPTp) under direct observation.
• Complete ANC “profiles” for timely diagnostic testing and risk screening.

These improvements ensure that each ANC contact adds value to maternal and newborn health.

CHPs have gained new skills in data collection, interpretation, and use for decision making. CHPs now conduct community malaria testing and link results to ANC follow-up. They also play a critical role in encouraging birth preparedness identifying high-risk pregnancies, and referring cases of gender-based violence for appropriate support.

Lessons and Policy Implications

Key lessons

• Early ANC booking remains essential; women who start in the first trimester are far more likely to complete all eight contacts.
• Integration of community and facility data systems improves accountability and responsiveness.
• Continuous communication between CHPs, HCWs, and data clerks drives early referral and consistent care.

For policymakers and implementers

• Scale up models that connect community health promoters networks with facility health information systems.
• Strengthen commodity supply-chains to ensure availability of essential ANC items.
• Address adolescent pregnancies through coordinated community and education sector interventions.

Conclusion

The C-It-Du-It approach demonstrates that when data linkages bridges the gap between community and facilities, the full eight-contact ANC model becomes feasible, even in resources limited settings. Strengthened data systems not only improve service delivery but also empowers communities to protect mothers and newborns through timely, coordinated care.

#CommunityHealthSuccessStory

 Written by Linnet- Lela Health Centre

Meet Jennie*: a young widow whose story echoes that of thousands living along the shores of Lake Victoria. These are women balancing survival, motherhood, and danger in ways the world rarely sees. Jeenie’s journey exposes the invisible struggles behind maternal health statistics, reminding us that every number has a name, a face, and a fight behind it.

I was left a widow at 32, with five children and a pregnancy…that was my sixth child to be, whom I hoped would bring back lost joy. … Fishing is the main economic activity here, so I joined the fisher-folk at Rambira Beach. I began fishing fingerlings every day, from 6 a.m. to 2 p.m. It is tiresome, especially with this pregnancy, however, I do not have any alternative, I must be strong.

Where Our Paths Crossed

I met Jennie in January 2025 at Lela health facility in Homa Bay County, where I work as a data clerk for the C-IT-DU-IT study, a collaborative initiative by Lvcthealth, KEMRI, LSTM, and the Ministry of Health. The project supports pregnant women and adolescents to access essential antenatal care (ANC) and tracks progress toward the recommended eight ANC contacts.

Jennie was among the few pregnant women who managed to come for care early, at her first trimester. But early attendance did not guarantee access. Without insurance under the Social Health Authority (SHA), she could not afford the required ANC profile tests. Jennie knew about the importance of SHA insurance but survival had other demands: Every shilling went toward feeding her children. Clinic visits became a choice she could not always make.

Work That Takes More Than It Gives

Life on the lake is unforgiving. Jennie spent hours standing in cold water, lifting nets, and working without meals until late at night. Exposure to waterborne diseases, toxic contaminants, physical strain, and unpredictable weather all posed silent threats to her health and her pregnancy.

“Every morning, my work involved physical strain of heavy lifting, prolonged standing and I could miss several meals, I mostly ate at night.” She recounts.

Her absence from follow-up appointments was recorded in the clinic register. Even the Community Health Promoter could not trace her during home visits as she was always out on the lake, trying to keep her family afloat.

A Loss That Ended Her Silence

At 16 weeks, Jennie began to bleed heavily and rushed to a nearby facility outside our C-it Du-it study site. Clinicians confirmed what she feared: she had lost the pregnancy.

This unborn baby was my hope…my last remembrance of my husband,” she said quietly.

Her grief was deep, but heavier still was the realization that the dangers she faced – long hours in the water, physical strain, missed meals, untreated conditions – had taken away something she desperately wanted to protect. And something shifted in her. The quiet suffering she had learned to live with could not continue – not for her, and not for the women around her. If she could not save her own pregnancy, she resolved to speak up so others might be spared her pain.

Jennie began sharing her experience with widows and young mothers in her community, explaining to them the risks hidden beneath the lake’s surface and the warning signs she once ignored, encouraging them to attend clinic visits. Her voice became a source of courage for women who, like her, face the same impossible choices she once did.

The Bigger Picture

Jennie’s journey is not an exception but a reality of countless women along Lake Victoria. Women who rise before dawn to work, who choose between healthcare and feeding their children, who face preventable dangers because the systems meant to protect them fall short.

Her story calls for urgent action:

• Support for widows and vulnerable households at the community level.
• Multiple measures and Ministry of Health action to ensure antenatal care is truly accessible, especially for women who cannot afford insurance or time away from income-generating work.

*Jennie is not her real name.

By Mandela Oguche and Linet Okoth, Intervention team

“There is a myth that community health workers cannot understand Quality Improvement (QI) concepts. We have busted that myth with the Du-it Community–Facility QI Model.”

For a long time, Quality Improvement (QI) was viewed as a technical process meant only for senior health managers and facility professionals. However, through the Du-it Community–Facility QI Model, tested within antenatal and maternal health services under the C-it Du-it project, we have learned that when community health workers (CHWs) are trained, guided, and supported, they not only understand QI — they excel at it.

This is a unique, first-of-its-kind approach that brings communities and facilities together in the same QI team. The model has transformed the way health facilities and communities collaborate to improve maternal and newborn health outcomes.

A Step-by-Step Learning Approach

A key feature of the Du-it model is its facilitated training process, designed to simplify complex QI concepts into practical, hands-on learning experiences. The training unfolds in three phases:

• Phase One: Short, focused training sessions introducing key QI concepts and tools.
• Phase Two: Practical sessions, where participants apply what they have learned directly in their work settings to solve real problems.
• Phase Three: Experience-sharing sessions, where teams reflect on what worked, what didn’t, and how they can adapt. Each QI cycle concludes with a Learning Event – a “festival of learning” – where community and facility teams showcase their progress, share innovations, and celebrate results.

As Lvcthealth, we have started implementing the Du-it model in Kenya since 2016. This iterative process has allowed teams using the Du-it model to continually adapt and expand, applying QI to a variety of maternal and child health interventions. This continuous cycle of learning has kept the model dynamic and responsive.

Who Makes Up the Work Improvement Team

Each Work Improvement Team (WIT) includes:

• Community health providers
• Community health supervisors
• The facility in charge
• A community representative
• Representative from community administration
• A member of a vulnerable group — for instance, an adolescent in the adolescent-friendly service WIT

This inclusive composition guarantees that diverse voices are heard and that solutions are guided by authentic community experiences. Through this structure, teams have learned to collect, understand, and analyze their own data — identifying issues affecting antenatal care, setting priorities, and developing interventions to address them.

One innovative solution that emerged in Homabay is the locator form. Initially, one facility struggled to match community health providers with the specific villages they served due to local naming differences. The locator form simplified this process by linking each provider to their community, improving home visits, follow-ups, and referrals — a simple but powerful innovation born from local insight.

The Du-it model is implemented and tested under the C-it Du-it study, funded by NIHR, to strengthen community-facility collaboration in improving antenatal care quality in Homa Bay County.

Data That Drives Action

By linking community-level data (eCHIS) with facility-level data (EMR), the Du-it model provides a complete picture of a mother’s journey — from identification in the community to care at the facility. This linkage enhances follow-up, reduces missed visits, and ensures continuity of care.

A recent study at a Homa Bay health facility revealed that 78.6% of ANC clients had missed at least one appointment, citing long distances and waiting times as the main barriers. Findings like these highlights why community–facility collaboration and data integration are essential to improve service access and quality.

Lessons for Counties and Sub-Counties

From the Du-it model, several key lessons stand out:

• Empower CHWs as part of QI teams — they are closest to the community and vital for identifying early challenges.
• Strengthen data integration between eCHIS and EMR systems for real-time decision-making.
• Encourage joint planning and reflection sessions where facility and community teams co-design solutions.
• Allocate county resources to sustain community–facility QI structures. Quality improvement should be institutionalized, not treated as a one-time project.

When communities and facilities work together, every mother and baby benefits. The Du-it model proves that QI is not about complicated tools — it’s about people coming together, building trust, learning continuously, and using data to drive action.

A Shared Responsibility

County and national policymakers, together with funders, have a vital role to play by embedding community-facility QI structures within routine maternal health systems, investing in adolescent-friendly antenatal care, and ensuring that SHA resources reach the girls and mothers who need them most.

Together, we can bridge the gap — one mother, one community, and one facility at a time.

By Edward Agolla, Trial team

Every conversation, every home visit, every referral is a chance to change the story of pregnancy care. When community health promoters and facility health staff work hand in hand, every contact truly counts.

Introduction

Within the vibrant communities of Homa Bay County, a new approach is transforming maternal health care. Community Health Promoters (CHPs) are leading a quiet revolution, ensuring every encounter with health services is valuable and worthwhile.

Having worked with the C-IT-DU-IT initiative, I have witnessed firsthand how CHPs are transforming maternal and child health in Homa Bay by successfully collaborating, adapting innovative approaches and, most of all, with relentless dedication.

Through collaboration with CHPs, Community Health Assistants (CHAs) who supervise CHPs and facility staff, pregnant women are reached and served in ways previously unimagined. “When CHPs, CHAs and facility teams unite, it builds trust, strengthens services and saves lives,” Nicholas Osoo, CHA.

This spirit of collaboration has reshaped how communities engage with maternal care in Homa Bay County.

Background

Maternal and child health challenges in Homa Bay County mirror those seen across and underserved regions globally, especially in Sub-Saharan Africa: limited access to health facilities, cultural barriers, and shortage of skilled health care workers. Overcoming them has meant finding strength within the community itself. CHPs have stepped forward as changemakers by linking mothers to clinics, sharing vital health knowledge, and proving that local leadership can drive lasting impact.

The Role of Community Health Promoters

CHPs have gone beyond the traditional health education roles. They are change catalysts, advocates for mothers, and community trusted link people. Through their actions, pregnant women are not only made aware of antenatal care (ANC) but are also enabled to access timely services, especially in hard-to-reach communities.

During a just concluded C-it-DU-it Learning event, it was evident that facilities using this collaborative strategy have seen major improvements: more women are completing eight ANC contacts as indicated, and more are starting ANC earlier than 16 weeks of pregnancy.

Pain Points in Maternal and Child Health

Despite dedicated health workers, there are several areas for improvement in Homa Bay County:

• Inaccessibility of health facilities in hard-to-reach areas.
• Personal or cultural barriers to attending ANC on time.
• Few skilled health care providers manage maternal complications.

Addressing these challenges highlights the value of CHPs in extending the reach of the health system by providing proactive, personalized support that connects underserved communities to essential maternal health services.

Stories of Impact

Consider the story of Ms. Jane Onyach, a CHP with Nyagoro Health Centre. She encountered a pregnant woman who had not attended any ANC sessions because she suffered from a mental health problem. Jane immediately informed the facility Maternal Child Health nurse, who contacted the facility in-charge. Together, they visited the woman at home, provided mental health support, and ensured she received the care she needed. The result? A healthy pregnancy and skilled delivery, which brought a healthy baby into the world.

Equally impressive is the story of Mrs. Jane Auma Sunga, another committed CHP. She Identified a pregnant woman whose relatives were reluctant to support her ANC visits on religious grounds. This left the woman uninsured and unbale to have ANC tests done. In a subsequent follow-up, Mrs. Sunga observed that the woman showed signs of Anaemia: she looked pale, could not walk unaided and had low blood pressure. Despite constant referrals, the woman did not go to the hospital. Realizing the urgency of the matter, Mrs. Sunga informed the CHA of the case. Together they conducted a home visit and helped the family realize how grievous the situation had become. Eventually, the family mobilized some money, and the woman was taken to the hospital for proper care.

“In our community, we rise together: every visit, every dialogue, every act of service moves it forward,” Mrs. Jane Auma Sunga, CHP.

Another CHP whose exemplary work was acknowledged during the C-it DU-it Learning Event is Ms. Florence Helidah Achieng. Within seven months she identified and referred 22 pregnant women early in their pregnancy. Her average household visitation stood at 95% and 9 of the women she identified attained the recommended 8 ANC contacts within six months. This illustrates how consistent community follow-up, early detection and strong linkages with facilities are beneficial for mothers and their babies.

These examples reflect how CHPs and facility teams are working hand in hand alongside each other. Beyond addressing individual cases, CHPs also facilitate community outreaches, coordinate vaccine and nutritional access, and serve as vital link between the health system and households.

Takeaways

The success of Homa Bay County points to some important lessons:

• Community engagement is central: Local wisdom ensures health interventions are relevant and effective.
• Collaboration works: Coordination between CHPs, CHAs, and facility staff results in improved maternal health outcomes.
• Every interaction counts: Regular follow-ups and home visits can save lives and result in healthier pregnancies.

Final Thoughts

In Homa Bay County, Community Health Promoters are not only health workers, but also agents of change. With dedication, innovation, and collaboration, they are showing that community-based health care can transform results for mothers and children. Every contact is an opportunity to make a meaningful difference.

Get Involved

Inspired by these initiatives? Join the movement. Empower Community Health Promoters. Whether through donations, volunteering, or assisting with awareness, your support makes every contact count toward a healthier future.

By Julia Scheibenreif

As part of my internship with Lvcthealth, I was invited to attend the 2nd C-it Du-it Learning Event in Homa Bay, Kenya. Although I knew little about community health in sub-Saharan Africa, I was eager to learn. What followed was a thought-provoking and humbling introduction to the realities of healthcare at the community level.

From the airport to acronyms: My journey begins

Arriving two and a half hours before the departure of my domestic flight to Kisumu felt completely normal to me – the product of a deeply ingrained German sense of punctuality. The other passengers, however, seemed to operate on a very different clock, strolling in just as boarding began, entirely unbothered.

My “community health” journey had officially begun. After a two-hour drive from Kisumu to Homa Bay, I found myself thrown straight into my first C-it Du-it meeting. Vicki, Linet, Mandela, and Jared were tossing what felt like endless stream of acronyms my way: WIT, CHP, CHA, eCHIS, SHIF, SHA, CRF, C-it, Du-it… all while preparing questions for the upcoming World Café session. I caught myself thinking, “Oh, I really should have read all those papers Vicki sent me.” But armed with only a pen and a notebook, I decided to dive in and learn by doing. Settling in and starting to understand.

There I was, squeezed into a small windowless meeting room, surrounded by boxes, people, and a topic I knew almost nothing about—not quite sure what would come next.

Settling in and starting to understand

The next morning brought a welcome change of scene: a stunning view from my hotel room window. Lake Victoria lay calm and peaceful in the morning light, as if to balance out the previous day’s whirlwind. Preparations started with breakfast around 8:30 a.m.—in Kenya, time is more of a reference point than a strict schedule, and everyone drifts in within a flexible window. It was a gentle reminder that I’d crossed not only borders but also cultures of time.

Vicki found the perfect task for me, one that helped me piece together the “community health” puzzle: printing handouts. The day passed quickly, and it was exciting to see everything coming together.

The moment everything “clicked”

“D-Day” arrived—the first day of the Learning Event. As mentioned, time is understood as a reference point, so participants began arriving from 7:30 am instead of the scheduled 8:00 am, while we were still busy printing and setting up.

As a former project manager for international medical conferences, where timing is everything, I took a deep breath and focused on being useful: preparing name tags, distributing masking tape, and greeting people as they arrived. Through these small tasks, I began to understand that behind all those acronyms were real people, communities full of dedication, passion, and ambitious goals to improve the health of pregnant women and their babies with very limited resources.

As the event went on, my understanding deepened. I learned about the many challenges mothers face in Kenya: missing identity cards, lack of health insurance, financial hardship, limited access to care, stigma, malnutrition, malaria, helminth infections, HIV, and shortages of medicines and testing kits.

From that moment, I felt a deep admiration for the Work Improvement Teams (WIT), Community Health Promoters (CHP), Community Health Assistants (CHA), the C-it researchers, the Du-it mentors, and the entire Lvcthealth team, who continue their incredible work despite financial challenges and funding cuts.

What I learned in Homa Bay

For me, these few days were more than just a professional experience; they were a lesson in resilience, empathy, and what it truly means to serve a community. I left Homa Bay not only with new knowledge but with a profound respect for everyone working to strengthen community health systems across Kenya and beyond.

If you want to know more about the C-it Du-it project, please visit: https://cit-duit.org/