Transforming Access to Maternal, Newborn, and Child Health among the Neglected and Isolated (TAMANI)

Organisation: Sign of Hope e.V.
Partner organisation in partner country: Self-implemented

Field Nurse Monica Goosh vaccinating a pregnant woman against tetanus during mobile outreach

Situation:

The Illeret and Dukana wards in the northern part of Marsabit County are extremely remote and underserved. Roads are largely impassable, electricity and communication infrastructure are largely lacking, and health facilities are often 8–75 km away, severely limiting access to medical care. Natural disasters such as droughts and floods, conflicts between local communities, as well as cultural barriers such as early marriage, FGM, and stigma around adolescent pregnancies further exacerbate the situation.

The region is highly vulnerable from a humanitarian perspective: food insecurity, malnutrition, water scarcity, and poor sanitation increase health risks, particularly for women and children under five. Mobile health services often remain the only accessible form of care, but they cannot ensure continuous support. Public facilities are understaffed, poorly equipped, and lack adequately trained personnel. While Community Health Volunteers provide important local support, they are often insufficiently trained and equipped.

Objectives:

Project Objective (Outcome)

The objective of the project is to contribute to the improvement of equitable access, continuity, and quality of health services for mothers, newborns, children, and general primary health care for remote and underserved vulnerable populations in Illeret and Dukana. At the same time, it aims to support sustainable health system strengthening and the achievement of Universal Health Coverage (UHC).

To achieve this objective, the project addresses the systemic and geographic barriers that have long excluded these communities from accessing health services. This is done by integrating a proven mobile health service model into more strongly anchored community and facility health systems.

The proposed project contributes to four key sub-objectives (Outputs):

Increased utilization and continuity of health services for mothers, newborns, children, and general primary care in remote and underserved communities.
Strengthened capacity and functionality of Community Health Volunteers (CHVs) to deliver community-based primary health care and maternal, newborn, and child health (MNCH) services.
Improved readiness and responsiveness of health facilities to provide quality MNCH care and primary health services, including referrals and emergency care.
Enhanced coordination and functionality of referral and communication systems in hard-to-reach areas.

Indicators:

Outcome

50% (1,553) of pregnant women in the target villages attend at least four antenatal care (ANC) visits by the end of the project (Baseline: 20.3% KHIS2 2025)
30% (932) of births in the target areas are attended by a skilled health provider (Baseline: 6.2% KHIS2 2025)
65% (2,879) of children under 1 year in the target villages are fully immunized by the end of the project (Baseline: 33.0% KHIS2 2025)
8,500 general outpatient consultations conducted annually through mobile outreach and in the target villages
85% (51) of CHVs remain active and reporting six months after training (Baseline: TBD)
90% (29) of trained health facility staff demonstrate competency in key MNCH areas (e.g., EmONC, IMCI) (Baseline: TBD)
17,695 individuals reached annually with general primary health care services

Output 1 – Expanded MNCH and PHC in 28 villages through mobile clinics, home visits, and linkage to four health facilities

336 mobile outreach visits conducted across the 28 target villages over 3 years
17,695 individuals reached annually through mobile outreach clinics in 28 villages
3 annual outreach maps developed/reviewed reflecting seasonal migration patterns and service routes
776 pregnant women reached/referred annually through structured CHV home visits and outreach
1,764 children under five treated for common childhood illnesses over 3 years
6,720 individuals (3,360 male and 3,360 female; 28 mother-to-mother and 28 male involvement groups) reached over 3 years through quarterly M2M groups and male forums

Output 2 – Strengthened CHV capacity for continuous community-based MNCH and PHC

60 CHVs trained on the Community Health Unit approach, MNCH, Integrated Case Management, and reporting using standardized national training modules
51 CHVs (85%) actively conducting household follow-ups and submitting reports six months after training
60 CHVs equipped with solar-powered mobile devices and digital/paper-based tools for communication, record-keeping, and referrals
144 monthly CHV peer review and mentorship meetings conducted at 4 health facility hubs over 3 years
60 CHVs receive quarterly performance-based incentives based on consistent performance, including timely referrals of pregnant women for ANC and delivery
48 joint CHV supervision and review reports completed across 4 health facilities over 3 years

Output 3 – Improved readiness and responsiveness of health facilities for quality MNCH and PHC, including emergency care and referrals

32 health workers (4 Clinical Officers, 6 Registered Nurses, 12 Enrolled Nurses, 4 Nutritionists, 4 Public Health Officers, and 2 Health Information Officers) trained and mentored on EmONC, IMCI, IMAM, adolescent services, and maternity care by end of Year 2
2 maternity waiting shelters constructed and operational at Illeret and Dukana Health Centres
1 maternity ward and 2 maternity waiting shelters equipped with solar power systems
2 teleconsultation linkages established between Illeret and Dukana Health Centres and North Horr Sub-County Hospital
2 Enrolled Nurses deployed and retained for performance-based supervision of CHVs and outreach coordination

Output 4 – Strengthened referral and communication systems

4 community–facility linkage desks established and functional at Illeret HC, Dukana HC, Telesagaye, and Bales Saru Dispensaries
60 CHVs and 16 health workers (12 Enrolled Nurses and 4 Public Health Officers) trained on referral protocols, emergency transport, and use of linkage tools
60 CHVs using color-coded referral cards and durable paper-based tracking tools
4 culturally adapted emergency transport units (donkey and/or camel carts) deployed and operational in underserved villages
4 Community Health Units oriented on managing and coordinating emergency transport options
60 CHVs provided with revolving treatment/diagnostic kits for basic case management at the community level
4 linked health facilities supported with essential medicines for basic outpatient and MNCH care
12 joint referral review meetings conducted annually between CHVs and health facility teams (1 per quarter × 4 facilities)
At least 180 emergency referrals coordinated and followed up annually through CHV–facility communication systems
12 quarterly coordination meetings attended by project teams with County and/or Sub-County Health Management Teams over 3 years

Measures:

The project will be implemented through interconnected activities that ensure the following:

Expansion of culturally adapted outreach and engagement to increase the utilization and continuity of MNCH and primary health care services: conducting monthly mobile health visits in 28 target villages, complemented by continuous home visits by Community Health Volunteers (CHVs); training CHVs in structured pregnancy tracking, postnatal follow-up, and newborn care; supporting mother-to-mother groups, male forums, and youth dialogues to promote MNCH service uptake; integrating culturally sensitive health education into community platforms; and aligning outreach and follow-up activities with seasonal migration using localized calendars.
Strengthening CHV capacity and functionality to provide continuous community-based PHC and MNCH care: a modular training approach covering MNCH, integrated case management, WASH, nutrition, gender-based violence (GBV), and mental health according to Ministry of Health standards; provision of essential CHV kits within a micro-enterprise model with revolving stock; formation of peer support groups and application of non-financial recognition strategies; provision of solar-powered mobile devices for communication, record-keeping, and referral coordination; and enhanced CHV supervision through joint planning with health facilities and outreach teams.
Improving facility readiness and quality of MNCH and primary health care services, including referrals and emergencies: clinical mentorship of facility staff on EmONC, IMCI, IMAM, adolescent services, and respectful maternity care; deployment of targeted clinical, nursing, and nutrition personnel; installation of solar systems to restore cold chain and lighting; construction of low-cost maternity waiting shelters using traditional materials; and establishment of teleconsultation links with North Horr Sub-County Hospital for complex maternal and child cases.
Strengthening referral and communication systems between communities and health facilities: establishment of community–facility linkage desks to improve case tracking and feedback; introduction of color-coded referral cards and durable paper-based tracking tools for low-connectivity areas; joint review meetings of CHVs, outreach, and facility teams; training CHVs and volunteers on referral protocols, emergency signs, and transport safety; and deployment of donkey- or camel-drawn carts as culturally appropriate emergency transport options.

Sustainability:

Sustainability

Institutional: The project is embedded within Kenya’s public health system and works closely with the Ministry of Health, the County Health Department, and the Sub-County Health Management Team. Four public health facilities are strengthened, and CHVs are recognized as part of the formal health workforce. Tools, protocols, and data are MoH-certified and integrated into KHIS2. Joint supervision, planning, and facility leadership create a foundation for long-term adoption and scaling. A transition strategy supports the integration of outreach, CHV supervision, and facility linkages into local systems.

Financial: The project leverages existing infrastructure and personnel while strategically using donor support to address critical gaps such as CHV kits, outreach logistics, and solar equipment. Solar energy and the use of community spaces reduce operating costs. In later phases, county authorities are expected to take over recurrent costs. The low-cost, flexible model is replicable and suitable for other underserved regions.

Technical: Simple, scalable technologies and national training packages build lasting capacity. Tools such as pictorial ANC trackers, color-coded referral cards, and solar-powered mobile devices are tailored for low-connectivity, low-literacy settings. CHVs and health workers are trained according to standard protocols and supported through mentoring. By combining mobile outreach, strengthened facilities, and referral systems, service delivery remains sustainable.

Community and Stakeholder Engagement: CHVs are nominated by their own villages, while elders, women’s groups, and local leaders support mobilization, scheduling, and follow-up. Structures like M2M groups, male forums, and community–facility linkage desks foster shared responsibility and trust. Feedback is collected through scorecards, storytelling, and suggestion boxes. Regular joint planning and review meetings strengthen long-term partnerships.

Human Resources: 32 health staff are trained and supported through mentoring. 60 CHVs are trained, equipped, and engaged through follow-up, performance incentives, and peer support. Two enrolled nurses link facility and community services, ensuring coordination and sustainable, people-centered service delivery.

Special features:

The TAMANI project is unique because it brings health services to extremely remote, underserved villages that otherwise have little access to care. It combines mobile outreach clinics, continuous home visits by trained CHVs, and strengthened local health facilities into an integrated system. Cultural considerations are incorporated through mother-to-mother groups, male forums, and locally adapted emergency transport. Color-coded referral cards, digital and paper-based tracking tools, and teleconsultations ensure continuity of care. The approach is sustainable, embedded within the public health system, standardized, cost-efficient, and designed for long-term adoption by local authorities. This creates a replicable, holistic model for hard-to-reach regions.