In rural Kenya, community health promoters(CHPs) armed with new training and streamlined procedures are identifying hard-to-reach children and connecting them to lifesaving vaccines, one household at a time.
Human-centered design
Vaccination
Capacity-building
Co-creation
In Rachuonyo North Sub-County, Kenya, community health promoters (CHPs) serve as the vital bridge between health facilities and underserved communities. Despite their critical role in promoting child vaccination, these frontline workers have historically operated with insufficient training, inadequate supportive supervision, and few practical tools and information, education, and communication (IEC) resources.
PATH Living Labs' baseline observations revealed that 85.7% of CHPs weren't using standard tools and procedures to verify children's vaccination status during household visits, resulting in missed opportunities to identify and support families with zero-dose and under-immunized children.
The challenge
Since 2019, PATH Living Labs has collected insights on the role of CHPs in promoting childhood vaccination through multiple user research activities targeting frontline health care workers.
Our research uncovered that CHPs are relied upon for enhancing vaccine education, linking caregivers to facilities, and facilitating community engagement. However, they received inadequate preparation for conducting comprehensive assessments and lacked structured mentorship, resulting in nearly nine out of ten CHPs failing to systematically assess children's vaccination status and identify barriers to immunization.
No practical, step-by-step guidance existed to help them systematically assess vaccination status and identify barriers. When CHPs did identify under-immunized or zero-dose children, they explored underlying reasons in only half of cases, limiting their ability to provide tailored support.
These gaps meant household visits weren't achieving their full potential for improving vaccination coverage.
The solution
Learning materials for the Quality Household Assessment and Sensitization (QHAS) initiative. Photo: PATH/Quinter Tabu.
The Quality Household Assessment and Sensitization (QHAS) combines intensive practical training with simplified standard operating procedures (SOPs) designed specifically for CHPs. Rather than imposing a top-down solution, PATH Living Labs co-created QHAS through workshops with CHPs, Community Health Assistants (CHAs), health care workers, caregivers, and sub-county health officials.
The intervention centers on a three-step procedure:
- Pre-visit preparation that sets up CHPs for successful engagement;
- structured visit start approaches to build rapport;
- and assessment and counseling that includes determining vaccination status using the mother-child health booklet, identifying barriers, classifying caregivers into relevant archetypes, providing tailored counseling, and documenting visits accurately.
QHAS also introduced dedicated activities for male caregiver engagement, recognizing fathers' key decision-making roles and support in children's health care access.
The simple IEC tools used in the intervention include: the mother-child health booklet (MCHB) for assessing vaccination records, a MCHB insert with simplified caregiver-friendly information for educating caregivers on immunization, a 3-step SOP guide to structure and standardize the household visit, and caregiver archetype tool for CHPs to reference tailored support for different caregivers.
The approach
Community health promoters in Rachuonyo North Sub-County, Kenya, at the training for Quality Household Assessment and Sensitization (QHAS) initiative. Photo: PATH/Quinter Tabu.
PATH Living Labs introduced QHAS over the last year, starting in December 2024, through phased pilot testing in collaboration with the Rachuonyo North Sub-County Health Management Team and Kenya's National Vaccines and Immunization Programme.
The team conducted qualitative research including focused group discussions, in-depth interviews, observations, and workshops, triangulating insights with desk research and quantitative administrative data to identify priority drivers of zero-dose and under-immunization. Through root cause analysis workshops, they pinpointed insufficient training and lack of CHP-friendly tools as the main issues related to suboptimal household visitations by CHPs.
Round one tested a low-fidelity prototype to establish the feasibility of delivering low-cost, targeted training alongside new procedures. Based on the results, the team conducted a refinement workshop to align training more closely with the SOP and enhance male engagement components. Before round two, research assistants shadowed CHPs during routine visits, documenting current practices and establishing a baseline for comparison.
The results
The structured approach proved feasible within existing resource constraints, requiring no expensive technology or complicated systems. CHPs demonstrated strong motivation to improve their practice when provided with clear, task-oriented guidance. The intervention successfully addressed the gap between CHPs' desire to serve their communities effectively and the practical knowledge and tools needed to do so.
The initiative demonstrated that breaking down complex community health roles into simple, step-by-step operational guidelines alongside intensive training and mentorship shows promise for improving CHP work quality. The low-cost, high-impact approach offers a realistic path forward for resource-constrained health systems.
PATH Living Labs is currently compiling results from the second round of pilot testing and developing recommendations for adoption and scale-up across Kenya and potentially other countries facing similar challenges in strengthening community health systems. In total, the initiative trained 71 CHPs and CHAs cumulatively from both rounds.