COVID-19 has affected nearly every facet of life in the last year, and around the world the pandemic has placed extreme burdens on healthcare systems and continues to negatively affect primary healthcare provision.

In an effort to slow the spread of COVID-19, the government of Kenya imposed a dusk-to-dawn curfew and closed the country’s international borders on 20 March 2020. While critical for the prevention of COVID-19, it also prevented many people from accessing preventative and essential health services, including prenatal care, across the country.

The reasons for the drop in access ranged from fear of arrest by police during curfew hours to fear of contracting the virus while seeking health services. This was further exacerbated by healthcare providers minimising in-person contact with their patients.

Assessing Health Services

In Migori County, Kenya, USAID’s Tupime Kaunti Project assisted the Department of Health in analysing data on key health performance indicators to determine the effects of the coronavirus pandemic on essential health services. The first analysis, in May 2020, focussed on data from between January and April 2020 and showed a steep decline in the outpatient utilisation rate from 22 per cent to 9 per cent. The proportion of targeted pregnant women provided with long-lasting insecticide-treated nets dropped from 113 per cent to a startling 26 per cent and first antenatal visit coverage from 113 per cent to 95 per cent.

“Indeed, services have been hurt,” said Kennedy Ombogo, Migori County Director of Public Health. “When the pandemic hit, we panicked, and attention was drawn to the containment measures, but we thank the data officers for flagging this one out during our briefs. This made us realise that no, we’re not doing well.”

To address the issues associated with the drop in utilisation of health services, the county introduced curfew passes for patients’ relatives and their transporters at all facilities, notified the public of the continued availability of health services through local radio broadcasts, provided enhanced integrated support supervision to affected sub-counties, and conducted targeted outreach on immunisation and family planning.

The department also connected pregnant women with their nearest health facilities through community health workers and reactivated the county toll-free line to reach adolescent and youth with information and services. As the pandemic continued, widespread lockdowns significantly affected the health, education, and trade sectors. Even though the county, in compliance with the national government’s requirements, had established structures to address the spread of COVID-19, it lacked a common framework to address post COVID-19 effects.

With technical assistance from the Tupime Kaunti Project, the Migori County Department of Health advocated for better coordination and use of data to inform response actions, resource prioritisation, and accountability at the County Multi-sectoral Emergency Response Team meeting in June of 2020.

As a result of the advocacy, the county developed a multi-sectoral COVID-19 response and post COVID-19 plan, which provides an overarching framework for coordination and aligning interventions by various sectors with the objective of slowing transmission, reducing mortality, and mitigating socioeconomic impacts of COVID-19 on citizens.

“As a department we want to thank our partners for coming in to help us produce this strategic plan for the next two years,” said Phidale Majiwa, Chief Public Health Officer. “It enables us to see the threats and embrace the opportunities available to deal with the pandemic.”

The two-year plan will strengthen the efforts towards eradicating COVID-19 and provide a framework for sharing responsibilities around COVID-19 investments.

Enhancing Epidemic Intelligence

Similarly, the Tupime Kaunti Project also facilitated the use of data in planning and epidemic intelligence in Nakuru County, where the project provided mentorship to the COVID-19 coordination committee to strengthen its command and coordination structure in line with national emergency operations centre requirements.

Members of Tupime Kaunti also mentored the surveillance and data management subcommittee on data collection using national tools, strengthening the reporting system and structures for COVID-19 data and analysing COVID-19 data and its timely submission to leadership for epidemiological intelligence to inform responses. In addition, the project provided technical assistance to the committee to visualise data using Geographic Information System maps and a weekly dashboard.

To enhance the quality of COVID-19 data for epidemic intelligence, project staff briefed the health information system unit on the national reporting system and addressed the gaps from some of the data collection tools to develop a county dashboard to visualise COVID-19 data.

The monthly and daily COVID-19 data was analysed and submitted to the coordination committee members for decision-making. One such data-informed decision was the conversion of Bondeni Maternity Hospital into a COVID-19 isolation centre to ease the burden due to increased positive cases in the area. The committee also utilised data to prioritise Nakuru East, Nakuru West, Rongai, and Naivasha sub-counties to pilot a home-based care strategy to relieve the Provincial General Hospital COVID-19 isolation site. In addition, when the data indicated an increase in infection transmissions to healthcare workers, the county shifted to improve training on infection prevention and control for healthcare workers from private facilities.

“We appreciate the Tupime Kaunti Project for the technical assistance to the Nakuru County coordination committee to have available data for use in planning and making significant decisions,” said Dr. Benedict Osore, Chair of the County COVID-19 Coordination Committee.

When health systems are overwhelmed, decision-makers need to make difficult choices to slow the spread of disease and mitigate consequences in select economic areas and populations to save lives and protect livelihoods. But having the right data at hand to better inform decisions and allow healthcare systems to pivot to demands has proven to make all the difference in Kenya as they face COVID-19’s rapidly evolving situation.

Lillian Mageto is Chief of Party of the Tupime Kaunti Project. She has experience in statistical modelling, global and reproductive health, survey design, and capacity development. Lillian is a community and social services professional with a Master of Science degree in social statistics from the University of Nairobi.

Palladium implements Tupime Kaunti (also known as the County Measurement, Learning and Accountability Program, or CMLAP) for USAID. The project supports ongoing efforts to strengthen measurement, learning, and accountability systems to provide high-quality data and synthesised information for planning, implementation, and decision-making in Kenya.