Champions at work: How CHPs help mothers and babies thrive in slums

Community Health Promoters have been empowered to identify danger signs in mothers and children, and ensure timely referrals. [Courtesy]

Ruth Wiza was in despair, bleeding heavily just three months into her pregnancy. Unaware that she was pregnant, she had been self-medicating at home, thinking the bleeding was just her period. Her feet had begun to swell and she feared for her life.

As she contemplated her next move, Beatrice Daisy Asige, a Community Health Promoter (CHP), knocked on her door, a visit that would ultimately save her life.Asige quickly identified danger signs in Wiza’s pregnancy and referred her to Bahati Health Centre, where scans revealed that the pregnancy was at risk.

At the facility, urgent interventions were carried out, stabilising both Wiza and her unborn child. Today, Wiza is eight months pregnant, attending Antenatal Clinics (ANC) regularly and preparing for delivery. “Without the CHP, I would have lost this pregnancy. She saved me,” says Wiza, a resident of Kiambiu slum.

Through regular household visits by CHPs, Wiza has been trained to recognise pregnancy danger signs such as fever, severe headaches, swelling of the feet and unusual pain. Additionally, Wiza has been equipped with knowledge on nutrition, proper hydration and balanced diet and the importance of exclusive breastfeeding for six months.

“Even as I await my newborn, I have learned about newborn care, recognising jaundice, timely immunisations and managing breastfeeding challenges such as nipple problems in the first 48 hours after birth,” Wiza tells The Standard during a visit at her home.

Trained by CFK and Save the Children, in collaboration with the Nairobi County Government on basic healthcare and CHP roles, Asige is skilled at identifying danger signs in mothers and children, providing essential health education and ensuring timely referrals.

The CHP has become an unsung hero within the slum, bridging the gap between households and health facilities.

At Sabana B, Asige trains mothers on pregnancy care, the importance of ANC visits, hospital deliveries, proper nutrition, exclusive breastfeeding, hygiene and safe pregnancy practices.

Immunisation schedules

She also ensures that infants and children up to five years complete their immunisations, monitors growth and distributes vitamins during household visits.Her work also extends to the Kangaroo Mother Care (KMC) programme, where she teaches mothers the importance of skin-to-skin contact to prevent infections and promote early bonding, especially for preterm babies.

“Through household visits, I have come across many patients silently suffering at home. For example, the community has normalised swelling of the legs and feet in pregnant women, not realising it could be a symptom of hypertension or other conditions that can be fatal,” the CHP laments.

Caleb Ouma, a CHP at Agare Unit in Kaloleni, says many women hide their pregnancies and only present at hospitals when they are due for delivery.

At that stage, some develop complications, and, in some cases, these can be fatal.“Through household visits, women now understand the importance of ANC visits, hospital deliveries, post-delivery care and newborn care,” Ouma explains.

He oversees 140 households, visiting at least 23 homes each month, identifying those in need of care and ensuring timely referrals to health facilities.
Through household visits, pregnant women share their expected delivery dates, their preferred delivery facilities and actively participate in birth planning. Birth planning includes ensuring financial security for deliveries. Women without medical cover are guided to enroll in the Social Health Authority (SHA) scheme to help offset hospital bills.

“I visit households to document health issues affecting families, but more importantly, I check on pregnant women, teaching them the importance of completing all eight ANC visits and monitoring newborns,” says the CHP. “I also educate families on nutrition, sanitation and water treatment to prevent common childhood illnesses such as cholera.”

Ouma, equipped with the Integrated Community Case Management (ICCM) tool provided by CFK, has supported 26-year-old Mildred Nelima, who is nine months pregnant and eagerly awaiting her first child.

Nalima, from Kaloleni, started attending ANC at three months, but she says the guidance she receives at home has made the biggest difference.

“Before, I didn’t even know what a CHP was,” she says. “Now I see how important they are. Their support is invaluable; they advise and encourage me every day.”She adds, “I am advised on what to eat, maintaining hygiene during and after pregnancy, avoiding physical harm and recognising danger signs associated with pregnancy.”

Manage emergencies 

A visit to her home revealed that she has prepared her delivery bag and registered with SHA to reduce financial strain during delivery. Her CHP has guided her on newborn care, breastfeeding and immunisation schedules, giving her confidence and peace of mind. “I expect a safe delivery. I’m ready to welcome my baby,” she says. The community health promoters were trained alongside healthcare providers.

The work of CHPs is complemented by huge improvements at health facilities. At Makadara Health Centre, Nurse Mary Wahome notes how training in emergency obstetric and newborn care is transforming maternal health services.

“Before the training, we frequently encountered obstetric emergencies, especially Post-Partum Haemorrhage (PPH) and pre-eclampsia. Our response options were limited and most cases were immediately referred,” Wahome explains.

Since the training, staff are better equipped to manage emergencies, practising peer-to-peer drills and gaining confidence in handling complex cases.

Previously, the hospital recorded 10 to 20 cases of PPH per month, most of which were referred for comprehensive care. Those numbers have now dropped to about five cases monthly.“Training on obstetric emergencies has empowered us to handle cases we couldn’t manage before,” says Nurse Wahome.

The hospital has also established a two-bed Kangaroo Mother Care (KMC) unit, which plays a vital role in the survival and healthy development of preterm and low-birth-weight babies, while reducing infections. Previously, preterm babies were cared for in general wards, putting them at higher risk of infections.

Before these interventions, training health workers, equipping facilities and strengthening referral systems, the sub-county faced major challenges: untrained CHPs, inadequate referral tools and gaps in identifying danger signs among mothers and newborns. Health workers lacked emergency obstetric skills, newborn care knowledge and access to KMC for preterm babies.

Maternal and perinatal death surveillance systems were also virtually non-existent. The improvements in maternal and newborn health indicators are credited to a maternal and newborn health project transforming care in Kamukunji and Makadara, two of Nairobi’s sub-counties previously flagged for poor health outcomes.

Mother and child health module

Dr Mirriam Etole from the Ministry of Health, Kamukunji Sub-county, notes that through the project, CHPs have been empowered using the mother and child health module, which enables them to identify and refer pregnant women and children under five to health facilities for essential services.

These services include antenatal care, safe delivery, postnatal care, immunisation and other support for mothers and young children. “For CHPs, we have strengthened the link between the community and health facilities, ensuring clients can seek care in hospitals. This has increased skilled birth attendance,” explains Dr Etole.

Dr Etole says the project has equipped both public and private facilities with the necessary skills and competencies to manage maternal and childhood emergencies. To strengthen emergency response, health workers have received comprehensive training in emergency obstetric and newborn care.

“We have empowered them to manage obstetric emergencies. The leading causes of maternal deaths are PPH, pre-eclampsia and birth-related tears. Health workers have been trained to handle these conditions,” she explains.

They have also been trained in Integrated Management of Childhood Illnesses (IMCI), focusing on the leading causes of death among children under five namely pneumonia, diarrhoea, malnutrition and malaria. The training equips health providers with the knowledge to correctly diagnose and manage conditions affecting mothers and babies.

Healthcare workers have also undergone training in Maternal and Perinatal Death Surveillance and Response (MPDSR). “This area was previously weak. When a mother died, we blamed ourselves. With MPDSR, it is ‘no name, no shame, no blame.’ We report, review and take action to prevent future maternal deaths,” says Dr Etole.

Essential newborn care now includes immediate interventions after birth, such as early initiation of breastfeeding to promote bonding, proper cord care to prevent sepsis and maintaining warmth.

Facilities have also improved the quantification of essential commodities to prevent stock-outs and identify gaps early.

Faith Naliaka, the project coordinator at Save the Children, says the initiative, launched in March 2024 and running until December 2026, is designed to reduce preventable maternal and neonatal deaths and bring Kenya closer to its 2030 health targets.

According to the Kenya Demographic and Health Survey (KDHS) 2022, Kenya records 355 maternal deaths per 100,000 live births, 21 neonatal deaths per 1,000, and 45 under-five deaths per 1,000.

“We focused on strengthening the full continuum of care from the community to the health facility so that mothers and newborns are supported at every step,” Naliaka explains.

The programme, which aims to reduce preventable maternal and perinatal deaths in Nairobi, links CHPs to health facilities through a strengthened referral system and equips facilities with essential tools, including digitised health information systems.

It also introduced integrated care so that mothers and babies are attended to by one clinician instead of moving between service points.

A major gap was the shortage of life-saving maternal health commodities, including oxytocin and carbetocin, which are essential for managing PPH, the leading cause of maternal deaths in Kenya.

Through the project, health workers have since been trained on essential maternal drug packages and management of common childhood illnesses. An assessment revealed that facilities lacked kangaroo mothers care rooms for preterm babies.

Under the programme, at least four facilities have been renovated and providers trained on quality preterm care.

So far, 25 preterm babies have been stabilised and discharged from these units, cases that would previously have required referral to higher-level hospitals. The project also works with county health managers to push for better budget allocation for maternal and child health. In just one and a half years, the impact is visible across the 40 supported facilities, for example skilled deliveries have nearly doubled from 8,000 in 2024 to over 15,000 in 2025.

Completion of the recommended eight ANC visits has also rose from 1,334 to more than 2,200 mothers.Additionally, there has been a drop in women dying at birth from 13 reported in 2024 to only 3 in 2025, with neonatal deaths declining from 430 to 221 over the same period.

“We have seen tremendous progress, but we still have work to do if we are to reach the 2030 targets. No woman and child should die at birth,” says Naliaka.

Etole attributes decline in maternal and child death to emergency obstetric training, mentorship and routine drills for healthcare workers.

For newborns, facilities are now better prepared to manage leading causes of neonatal deaths, including sepsis and low birth weight using interventions such as kangaroo mother care and improved resuscitation skills gained from essential newborn care training.

“We have had strong supervision from the project. It supports 20 facilities in Kamukunji, ensuring healthcare providers conduct data quality audits and use community scorecards. This has improved accountability and service delivery,” she says.

On-the-job training

With the programme, at least 200 CHPs and 309 healthcare workers have been trained in emergency obstetric and newborn care, MPDSR and integrated management of newborn and childhood illnesses and quality of care standards.

The project directly reaches over 37,000 children under five and 16,000 pregnant and lactating women through immunisation, skilled birth attendance, ANC, post-partum care and treatment of childhood illnesses. As the project winds down in 2026, the health partners are preparing county-based trainers to sustain the gains through ongoing mentorship and low-cost, on-the-job training.

Jane Ouko, a Programmes Officer at CFK, says the intervention has greatly strengthened community-level care for mothers and newborns.

CFK conducts quarterly support supervision across 40 health facilities, helping to strengthen the quality of services offered. The organisation also works closely with partners involved in child health activities, including the Nairobi County Child Technical Working Group, which holds biannual meetings. In addition, it conducts refresher training for CHPs on maternal, newborn and child health.

“We work directly with the community, addressing issues of newborn and maternal health, exclusive breastfeeding, nutrition, hygiene and improving the referral system,” she explains.

CHPs in both Kamukunji and Makadara sub-counties have been equipped with referral tools and trained on how to use them during household visits.

They also participate in quarterly review meetings to boost morale, share challenges, and support one another in their community health roles. Additionally, communities are encouraged to form care groups to ensure maternal and child health knowledge remains active and shared. “CFK supports health facilities with data quality audits, helping improve the accuracy and reliability of records,” adds Ouko. “We have seen real improvement, and we hope both county and national governments will sustain these activities.

“Through the programme, Makadara Sub-county, which previously recorded high maternal and child deaths, has strengthened maternal and perinatal death surveillance, formed a committee to review cases and near-misses, and introduced six-monthly data quality audits.

“To boost ANC visits, facilities now offer small incentives to pregnant women, such as baby wraps and lesos, for completing all eight visits,” says Hassan Somane, the Sub-county Medical Officer of Health, Makadara. Though maternal and child health has improved, Somane notes that more investment is still needed at both facility and community levels.