Motivation:
Maternal and child health outcomes in Kenya remain constrained by barriers to timely care, uneven health coverage, and gender-based disparities in access to services. Digital platforms such as the national electronic Community Health Information System (eCHIS) and the CHV-NEO (Community Health Volunteer–Neonatal) text messaging intervention have emerged as promising tools to strengthen the work of community health workers (CHWs) and expand women’s access to information and support. While CHWs are critical providers of household-level care, the impact of their digital engagement and perinatal women’s participation in mobile health interventions remains underexplored. Building on the ongoing CHV-NEO trial in Kisumu County, this study investigates whether integrating eCHIS and interactive text communication improves maternal and newborn care, reduces disparities in digital access, and provides a financially sustainable model for strengthening community health systems.
Objective:
The study extends the CHV-NEO randomized controlled trial to assess digital engagement and its impact on maternal and child health outcomes. It will recruit 1,000 additional perinatal women across sites randomized to receive either standard eCHIS services or enhanced eCHIS with CHV-NEO text communication. The study will examine whether CHW engagement with eCHIS and perinatal women’s text messaging predict improved outcomes, including antenatal and postnatal care attendance, breastfeeding, family planning uptake, vaccination rates, and neonatal care-seeking. The study will also identify characteristics of CHWs and women associated with higher or lower digital engagement through mixed-methods analysis. Finally, the study will generate a micro-costing analysis to estimate the financial implications of implementing eCHIS with and without integrated messaging at scale. Importantly, the study incorporates an empowerment lens by examining whether digital connectivity strengthens women’s autonomy in health-related decision-making and ensures that benefits are equitably distributed.
Proposed Impact:
Findings will inform policymakers on whether digital engagement improves maternal and newborn outcomes, which groups of women and CHWs are best served or left behind, and how much it costs to implement such tools at scale. The results will be directly relevant to Kenya’s Ministry of Health, which has already adopted eCHIS nationwide, and to other countries using the Community Health Toolkit. If effective and affordable, this model could serve as a blueprint for integrating digital tools into community health systems globally.
