How Digitally Empowered Community Health Promoters Are Saving Mothers And Children In Kisii And Nyamira

By Elizabeth Angira

It is almost midnight in Itumbe, Kisii County. Outside, the silence is broken by the chirping of crickets and the distant barking of a dog. Inside her homestead, 35-year-old Gladys Nyamache is sweating and struggling with sudden labour pains, unsure of what to do.

“I was alone and scared about the possibility of losing my baby or dying, as my husband had travelled,” recalls Ms. Nyamache.

In the bleak moment, a thought struck her.

“Why not call Celine Nyasuguta Mokano, who has been helping other pregnant women in our village in such times?” Her quick thinking saved the day.

Ms. Mokano, a community health promoter, swung into action, alerting a boda boda rider and the nearest clinic the moment she received the desperate woman’s call. She arrived within minutes.

“I gave birth safely to my daughter at the health facility,” Ms. Nyamache says with a smile, cuddling her now two-month-old baby.

Unsung heroes

Ms. Nyamache’s story is similar to those of other expectant mothers across Kisii and Nyamira counties, whose lives have been saved by unsung heroes – community health promoters (CHPs). These digitally empowered health volunteers are leading a quiet but transformative maternal health revolution.

“They (CHPs) educate and train us on sexual and reproductive health, maternal care, and general health matters,” says Ms. Nyamache.

They also visit expectant mothers to check their blood pressure, remind them of clinic dates via phone calls, and offer nutrition advice.

According to the Ministry of Health, CHPs are volunteers forming part of a community health unit, each serving a population of approximately 5,000. Each community health unit is assigned one Community Health Assistant (CHA) and 10 CHPs who offer promotive, preventative and basic curative health services. They are governed by a Community Health Committee (CHC), and each unit is linked to a local health facility.

These units have become integral to Kenya’s maternal and child health efforts.

In 2019, the maternal mortality ratio (MMR) in Nyamira was 349 per 100,000 births, and 325 in Kisii, both of which were better than the national average of 355 per 100,000 births, according to the 2019 census.

A 2025 study identified common causes of maternal deaths as obstetric haemorrhage (39.7%), hypertensive disorders (15.3%) and non-obstetric complications like anaemia (19.8%). Healthcare worker-related factors include delays in starting treatment (32.9%), inadequate monitoring (26.9%), inadequate clinical skills (28.1%), prolonged abnormal observation without action (23.6%), and incomplete initial assessment (22.7%).

The same study noted that sub‑national differences in MMR arise from factors like socioeconomic status, access to facilities, cultural norms, and health system capacities.

The infant mortality rate stands at 21 per 1,000 live births, resulting in around 33,600 deaths per year (an average of approximately 92 per day). The stillbirth rate stands at 19 per 1,000, causing approximately 30,400 stillbirths annually (an average of approximately 83 per day).

“Nearly half of these babies were alive at the onset of delivery but succumbed during the process due to complications,” says UNICEF.

Yet, more needs to be done.

UNICEF points out that the Sustainable Development Goal (SDG) 3 expects all countries to reduce the maternal mortality ratio to less than 70 per 100,000 live births, neonatal mortality to 12 per 1,000 live births and under-5 mortality to as low as 25 per 1,000 live births.

Bridging the Gap

Ms. Mokano, 63, and other CHPs traverse their operation areas, walking door to door, phone in hand, to reach expectant mothers. They log data into the Electronic Community Health Information System (eCHIS), a Ministry of Health-backed app that tracks pregnant women’s health data, including gestational age, clinic visits, iron supplement intake, and danger signs like bleeding or swelling.

“The app guides me step by step. It even sends alerts if a mother misses her clinic day,” says Ms. Mokano, who was first trained in 2008.

Back then she worked with just a pen and paper.

“I used to forget things or lose my notebook,” she laughs. “Now I can pull up records from six months ago. It helps me plan better.”

She dedicates four days a week to visiting households, offering education on safe delivery, family planning, sexual and reproductive health and gender-based violence.

“I have successfully handled more than twenty pregnancy cases,” she says proudly. “This work is a calling. People trust me because I build rapport and keep their secrets.”

That trust was hard-won. At first, Ms. Nyamache was sceptical about sharing her personal health information with someone from her own village. However, trust gradually replaced hesitation.

“She (Ms. Mokano) never judged me,” Ms. Nyamache says.

“When she used her phone to follow up with the clinic, I felt like she truly cared. This time, I gave birth at a facility, and both my baby and I are healthy,” says Ms. Nyamache, who used to deliver at home.

Jane Kemunto, a mother of three from Nyamira, credits her CHP with saving her life during a complicated pregnancy.

“I had no idea my swollen feet were a sign of danger,” she says. “My CHP urged me to go to the clinic immediately, where I was told my blood pressure was dangerously high. I got treatment just in time.”

Despite high antenatal care (ANC) coverage, gaps remain. According to the 2022 Kenya Demographic and Health Survey, 97.9 per cent of women nationwide receive ANC from skilled providers, yet only 29 per cent begin in the first trimester, and just 66 per cent complete the recommended four visits. Moreover, 11 per cent of births still happen at home, particularly in under-resourced or remote areas. Community health promoters bridge the gap, linking women to professional care.

When Phones Save Lives

Their efforts are bearing fruit as data from the Kisii County Health Department show a 34 per cent increase in skilled birth attendance in areas with digitally trained CHPs since 2021. In Nyamira, maternal deaths have declined by 29 per cent in digitally mapped zones since 2022.

Dr. Magret Mogaka, a maternal health officer in Kisii, describes the shift as remarkable.

“Previously, women arrived at facilities late, if at all. Now, referrals are quicker, and more women are delivering in facilities. CHPs are at the heart of this transformation,” says Dr. Mogaka.

A 2024 internal review by the Nyamira County Health Department found that digital CHPs reached more households than any other health worker, at the lowest cost-per-patient ratio, making them ideal for advancing Kenya’s Universal Health Coverage (UHC) Strategy.

Kenya’s UHC Policy 2020–2030 recognises community health as central to primary care in line with constitutional and Vision 2030 commitments. In late 2023, Parliament passed three key health laws that reinforce this approach: the Primary Health Care Act formalises community health units and the role of community health promoters; the Digital Health Act establishes infrastructure for an integrated health information system; and the Social Health Insurance Act transitioned NHIF into the Social Health Authority, creating the Primary Healthcare Fund to support healthcare delivery at the community level. Fully implemented, they formalise community-level care and guarantee sustainable funding, making CHPs integral to Kenya’s long-term health goals.

Sustained Investments, But Gaps Remain

At the county level, counties like Kisii and Nyamira are also taking steps to formalise community healthcare. Kisii County allocated Ksh88.2 million to CHPs in its 2024/2025 budget and reported disbursing monthly stipends to 2,500 CHPs during the financial year. These investments have reportedly expanded increased coverage of Level I services in line with universal health coverage (UHC) goals. The county also reported that it distributed smartphones and kits to 2,841 CHPs, who were issued log-in credentials for eCHIS and started online household registration across the county and achieved 100% community coverage. A projected 2,945 CHPs are set to receive stipends in the 2025/2026 financial year.

Though the budget emphasises primary and universal health care, explicit line items for community health volunteers (CHVs) or community health units (CHUs) aren’t detailed in the public summary, suggesting they may be designed into broader primary healthcare allocations rather than listed separately. The success of digital integration relies heavily on non-governmental organisation and donor collaboration.

“We rely heavily on development partners to train CHPs and roll out digital tools,” says Dr. Mogaka “The counties are gradually integrating this system into our broader health strategy.” According to Dr. Mogaka and county health sources, the county partners with organisations like Medic Mobile, which has played a role in training 2,500 CHPs, supplying mobile phones and data collection tools and in digital integration with eCHIS.

Nyamira County

In neighbouring Nyamira County, the county government allocated Ksh88,740,000 to CHPs in 2024/2025, including an allocation from the national government. On June 13, 2025 the county government reported paying stipends to 1,379 CHPs for the 2024/2025 financial year. Non-governmental organisations such as PATH have also supported community outreach by training 1,440 community health volunteers (CHVs) to integrate HIV and tuberculosis services and providing 2,017 smartphones and tablets to enhance the use of eCHIS.

Nyamira also passed and implemented the Community Health Services Act (2022), which provides for allowances for CHVs or reimbursement for out-of-pocket expenses, with specifics determined by the County Executive Committee Member for Health, the County Volunteer Health Advisory Committee, and the County Public Service Board.

These county-level investments underscore a growing commitment to formalising community health, which has long relied on volunteers. However, despite these gains, there is mounting pressure to formalise and sustainably fund community health and to recognise CHPs as part of the health system. CHPs are calling for monthly stipends, airtime support, transport facilitation and official recognition.

As counties scale up investments in community-level services, CHPs are bringing the policies to life. In Bomachoge Chache in Kisii County, 43-year-old Peter Onchiri supports maternal and child health using SMS alerts, apps, and automated referral systems. His tech-enabled approach is especially vital in remote areas with poor roads and distant health facilities.

Mr. Onchiri recalls one night when he got a call from a man whose wife was in labour and bleeding.

“I’d marked her as high-risk due to previous complications,” he says. “I called the health facility and requested an ambulance, which picked her just in time for a safe delivery.”

Since his training in 2007, Mr. Onchiri has handled over 30 maternal cases.

“Maternal deaths were common before. Now, with technology and training, I respond faster, and people trust me more,” he explains.

Some incidents, however, leave painful, lingering memories.

“There was a defilement case I handled that still haunts me,” he admits.

Through tools like eCHIS for maternal alerts and WhatsApp groups for real-time coordination, CHPs like Mr. Onchiri and Ms. Mokano have become frontline responders during maternal emergencies.

Championing Male Involvement

CHPs are also transforming attitudes in communities where reproductive health is often seen as “women’s business”. They are engaging men in maternal education, thereby strengthening support systems for mothers.

Ms. Mokano and Mr. Onchiri now host “father circles” where men learn about birth preparedness, nutrition, and postnatal care.

“Some men used to leave everything to the women,” Ms. Mokano says. “But now they ask questions, attend clinics with their wives, and proudly care for their babies.”

Samwel Momanyi, 30, from Kisii, says he never understood maternal health until CHPs began organising group discussions for men.

“She explained things I never knew: how to support my wife, what to watch out for, and when to seek help. Now, I attend clinic visits with my wife. It’s our journey,” he smiles.

Erick Nyabuti, a father of twins, says the awareness helped him support his wife better.

“I became her biggest cheerleader. I helped with baby care and breastfeeding positions and knew the signs of postpartum depression,” he says. “The CHP involved me in every visit.”

CHPs are trained to include fathers in antenatal and postnatal education, helping them see their role beyond providing financially.

“When a man is informed, he supports better. Now, I remind my wife to take her supplements and accompany her to the clinic when I can,” adds James, another father from Kisii.

Challenges

Yet despite their success and impact on maternal health, CHPs face challenges that impact their ability to do their work effectively, including low pay, lack of transport, and minimal government recognition. Many still work as volunteers, operating without formal contracts or consistent stipends.

“I walk up to 10 kilometres a day,” Mr. Onchiri says. “I use my airtime, and sometimes I am unable to respond fast during emergencies due to a lack of transport.”

Ms. Mokano says that when her phone’s screen cracked last year, she had to borrow a neighbour’s device to update her health records.

“We need better phones, airtime, and mobility support,” she says.

These challenges persist despite growing recognition of the critical role CHPs play in primary healthcare. Dr. Mogaka acknowledges the significant impact Community Health Promoters (CHPs) have made on maternal and child health outcomes.

Dr Mogaka emphasises, “Investing in CHVs is not a luxury; it’s a public health necessity. If we want to reduce maternal and infant deaths, we must treat CHVs as essential, not optional.”

As counties race to meet national UHC goals, the quiet, persistent work of CHPs may well determine whether mothers and babies survive and thrive beyond the delivery room. With sustained investment, CHPs could help close Kenya’s maternal and child health gaps, one household, one phone call, one safe birth at a time.

This article was produced with the support of the Africa Women’s Journalism Project (AWJP).