Edwin Nguku

By Benson Omondi and Jared Odaro

“We no longer get verbal reports; now everything is documented by the CHPs at the household level. It is encouraging us without a push to do our household visitations.” This sentiment from a Nurse and Community Health Promoter (CHP) captures the transformative impact of the Community Health Promoter Case Report Form (CHP-CRF)  which can be found as additional pages in the mother and Child Health (MCH) Book which every mother carries.

For years, County Health Management Teams have grappled with what one Deputy Nursing Officer aptly called “the elephant in the house“—the persistent challenge of documentation at the community level. Services were being delivered, lives were being touched, but without proper documentation, these critical interventions remained invisible in our health systems. This created a blind spot in our health information systems and made it nearly impossible to track the complete journey of mothers through the continuum of care.

The question that kept many of us awake was simple yet profound: How do we bridge this gap between community service delivery and facility-based care?

Bridging the Documentation Divide

The solution – and indeed – innovation lies not just in creating another form, but in its thoughtful integration into existing systems. This form was developed and revised jointly with County and subcounty reproductive health coordinators from six sub counties, as well as County and subcounty community health focal persons from the study areas. Three rounds of piloting were conducted with these stakeholders’ involvement.

Additionally, consultative meetings were held with County and Ministry of Health stakeholders, where issues such as duplication were addressed before deployment. The form’s design fits neatly into the handheld mother-child booklet and contains a section for Community Health Promoters (CHPs) to complete during home visits, as well as a section for healthcare workers to provide comments after reviewing the CHPs’ entries.

The CHP-CRF has become a seamless part of the documentation tools mothers already carry. It is issued either at the ANC clinic or during home visits, ensuring that every mother’s journey is captured from the very beginning.

Co-Creation: The Foundation of Success

What sets this initiative apart is the deliberate, inclusive approach to its development. Rather than imposing a top-down solution, stakeholders at county, sub-county, and facility levels were brought together to co-create this tool. This wasn’t merely about orientation sessions; it was about genuine engagement—listening to frontline workers, incorporating their insights, and building on their experiences.

This collaborative approach has yielded remarkable results. When you listen to CHPs speak about the form, their passion is palpable. They don’t view it as additional bureaucratic burden but as a tool that validates their work and enhances their professional identity. As one CHP shared in a recent video, the form has fundamentally changed how they approach their work. https://photos.app.goo.gl/zTofjVxjWVELhoCH9 

The Evidence Speaks: Multiple Perspectives

The impact of the CHP-CRF resonates across all levels of the health system. For CHPs themselves, the form provides structure and recognition for their work. They report feeling empowered and more professional in their interactions with families. The documentation transforms their role from informal advisors to recognized healthcare providers with accountability and standards.

Healthcare workers at facilities have found the form invaluable for two critical functions: monitoring clients’ journeys through the health system and supervising CHPs. The shift from verbal to written reports has enhanced accountability and made supervision more objective and evidence-based. Supervisors can now track patterns, identify gaps in service delivery, and provide targeted support to CHPs based on documented evidence rather than anecdotal reports.

Perhaps most significantly, mothers themselves are aware of and value the booklet. They understand what is documented within its pages. One mother shared a particularly poignant insight: “It even allows the doctor to see the things I am afraid of telling them.” This reveals how the form serves as a communication bridge, enabling more comprehensive care by capturing information through trusted community health promoters, that might otherwise remain hidden due to fear, stigma, or forgetfulness.

Addressing Concerns and Moving Forward

While the enthusiasm is encouraging, County Health Management Teams have rightly raised concerns about sustainability. Will this initiative face the same documentation challenges that have plagued other programs? The key to avoiding this pitfall lies in recognizing that the CHP-CRF is not just another form—it’s a cultural shift in how we value and capture community-level health work.

Some have noted that similar documentation exists in the MCH booklet[FO5] . However, the CHP-CRF fills a specific gap: it documents the CHP’s activities, observations, and interventions at the household level before and between facility visits. It captures the invisible work happening in homes across our counties, work that is critical to maternal and child health outcomes but has historically remained undocumented.

The Path Forward

For County Health Management Teams, the CHP Case Report Form represents an opportunity to finally solve the documentation challenge that has frustrated us for years. It provides accountability without creating unmanageable burden. It motivates CHPs by recognizing their work. It improves continuity of care by ensuring information flows seamlessly from community to facility and back.

The “silent supervisor” is working—not through enforcement or punishment, but through empowerment and recognition. When CHPs say the form encourages them “without a push” to complete household visitations, we know we have found something that aligns professional standards with intrinsic motivation.

As we scale this innovation across counties, let us remember that its success lies not in the form itself, but in the collaborative spirit that created it and the genuine value it provides to all stakeholders—from CHPs to healthcare workers to the mothers and children we serve.

We are slowly bridging the gap and documentation at the community level is becoming a reality, one household visit at a time.

By: Wycliffe Kadweya, QA Study Nurse

Accurate newborn weight data is the most essential indicator of maternal and child health research. It guides interventions, informs policy, and tracks progress in reducing neonatal morbidity and mortality. Yet, even with the right tools and training, data integrity can be lost at the point of care — a reality we have observed in C-it Du-it study sites within Homa Bay County.

Digital Weighing Scales Distributed, Training Conducted

Each of the 18 study facilities received two digital weighing scales — one for the maternity and one for the Maternal and Child Health (MCH) department. All health care staff in these departments were thoroughly trained in their use, maintenance, and proper recording of the weights in facility registers and study instruments.

To ensure reliability and consistency across various locations, the research team regularly calibrated and maintained the electronic scales. The goal was to eliminate estimation errors and ensure reliable data collection, particularly for newborn and infants’ weights, critical indicators for monitoring child health outcomes.

Old Habits Die Hard

Despite these efforts, a number of health workers continue to use the traditional mechanical scales that are less precise and more prone to calibration drift. This has led to the persistent problem of rounding and “data heaping” where baby weights cluster around specific familiar numbers such as 2.5 kg, 3.0 kg, or 3.5 kg.

For infant health research, this seemingly small issue can distort true weight distribution, hide low-birth-weight cases, and weaken the validity of the data we depend on.

Why the Change Hasn’t Stuck

Follow-up quality assurance visits and informal conversations revealed several reasons for the gap between training and practice:

• Comfort with old ways: Several providers trust the mechanical scales they have always used.
• Fear of failure: Some facilities worry about battery issues breakdown during busy clinic days.
• Pressure to work quickly: On busy clinic days, old habits can feel faster, even if they are less accurate.
• Limited supervision: Without regular check-ins, adherence to digital weighing practices can slip.

The Cost of Inaccurate Data

A difference of 0.2 kg may seem small but in research and program it matters. Inaccurate weights can mask cases of low birth weight that require special care and follow-up. Over time, these errors undermine the reliability of our findings and weaken the evidence that shapes maternal and child health decisions.

Helping Good Practices Stick

To bridge this gap between training and practice, we suggest

• Supportive supervision: Include direct observation of weighing practices during monitoring visits, with immediate feedback.
• On-site mentorship: Short, focused sessions to refresh skills and remind staff why precision matters.
• Recognition and accountability: Celebrate facilities that consistently use digital scales correctly during review meetings.
• Ongoing data audits: QA teams can continue checking data clusters and help correct inconsistencies early.

Conclusion

Technology itself cannot ensure quality – people do. The rollout of digital weighing scales at our research sites has been a major step forward, but sustained mentorship, supervision, and accountability remain key.

Accurate data is not just a research requirement but a reflection of the care and attention every baby deserves.

Because quality care begins when we choose precision over habit.

The Challenge

In many Kenyan counties, pregnant women first engage with Community Health Promoters before reaching antenatal care (ANC) services at health facilities. But communication gaps between the community and the clinic often mean delays, missed appointments, or duplicated records. With Kenya now aiming for eight ANC contacts during pregnancy, these gaps risk leaving women behind.

The Innovation

Through the C-it DU-it programme, we developed a unique electronic linkage module that connects two government systems:

• eCHIS (electronic community health information system), and
• KenyaEMR (facility-based electronic medical record).

For the first time, referrals can move smoothly and electronically between the community and facility, allowing referrals and follow-ups to be tracked and monitored in real time when systems are online. This innovation is critical because until now, the two systems worked in isolation, leading to duplication, gaps in care, and poor data use. The linkage brings:

• Continuity of care – women can be followed from household to facility.
• Better decision-making – complete, accurate data at all levels.
• Efficiency – reduced duplication and errors.
• Trust and accountability – stronger links between communities and health facilities.

To complement this, we also adapted the widely used Mother–Child Booklet, creating the Community-Enhanced Mother-Child Booklet. Rather than altering its existing content, we simply added a dedicated section for Community Health Promoters to record household visits. This means that facility staff can view a woman’s full history at a glance. Both facility teams and community units report that this small adaptation has transformed coordination, improved trust, and saved time.

The Impact

The adapted Mother-Child Booklet has quickly become more than just a record: it is seen as a silent supervisor, an accountability tool, and even a source of motivation for Community Health Promoters (CHPs). Nurses value being able to see at a glance who the CHP has already visited, while CHPs appreciate that their work is visible and recognized.

One CHP explained, “I ask the woman, ‘who is your CHP?’ then I text them. It helps us follow up.”

The Community Referral Form (CRF) section has become a practical way of communicating between the community and the clinic. It reduces duplication, ensures timely follow-up, and strengthens collaboration: “The CRF helps you to do the follow up … it is another way of supervision and appreciation.”

While a few challenges remain, such as women living with HIV not always wishing to share their booklet, the overall feedback is overwhelmingly positive. Health workers describe it as simple to use, not burdensome, and a tool that should continue even after the C-it DU-it project ends: “When C-it DU-it leaves, the CRF must remain … it should be adopted nationally!”

Through training and joint support, the CRF has given both CHPs and facility staff a stronger sense of connection, coordination, and purpose. As one CHP put it: “It is a motisha (motivation).”

The Way Forward

The strong endorsement from both CHPs and facility staff who repeatedly stressed that the CRF “must remain” and “should be adopted nationally” has caught the attention of county health managers. Building on this momentum, there is growing consensus that the adaptation should be scaled beyond the pilot counties.

At the same time, the electronic linkage is opening doors for a new era of seamless data use between communities and clinics, not only for ANC but also for wider maternal, newborn, and child health services.

By “seeing it” (C-it) and “doing it” (DU-it), we are making data work for mothers, babies, and health teams alike.