Third Term Project: Gilgil Sub-County, Nakuru County, Republic of Kenya

From June 2023 to May 2026, SHIONOGI and World Vision Japan implemented a project in Kiambogoko, Gilgil Sub-County, Nakuru County, Republic of Kenya, to improve the health of pregnant and breastfeeding women and children under five.

 

Working through two health centers and two dispensaries, we improved health facilities, strengthened the capacity of healthcare workers, and conducted education and awareness-raising activities for community members. Through these activities, we worked to improve the quality of maternal and child health services and promote a sustainable, community-led health system that supports the health of mothers and children.

Nakuru County is one of the most populated areas in Kenya and is home to various ethnic groups. Many of the residents in the support area are small-scale farmers. When the rainless season lasts on, some residents may move to neighboring communities in search of employment.

The support area has problems such as a delay in infrastructure development for health facilities and crowded of patients at one health center from all over the area. These problems have resulted in the situation where community people are unable to receive sufficient basic medical services when needed.

Other challenges include child nutritional status, such as stunting and underweight, and low access to improved sanitation facilities. Regarding water hygiene, diarrhea in children is also an issue.

Building on the approaches used in previous M2M projects and reflecting the local context in Kiambogoko, we worked to improve Maternal, Newborn and Child Health (MNCH) by improving access to healthcare in remote areas and strengthening community health systems, including Mother to Mother support groups (M2M groups).* We also set the reduction of diarrhea cases among children under five as a specific indicator and placed particular emphasis on Water, Sanitation and Hygiene (WASH) activities.

*Groups in which mothers in each community teach and learn from one another about maternal and child health and nutrition (peer education).

1. Improving Access to Maternal and Child Health Services

To improve access to and the quality of health services for pregnant women, mothers and children, we improved health facilities, strengthened healthcare workers’ capacity, and promoted preventive health education and the use of health services by forming and strengthening Community Health Volunteer (CHV) networks and Mother to Mother groups.。

Key activities

1. ・Construction of a maternity block and renovation of an existing block at Kiptangwanyi Health Center
2. ・Provision of medical equipment and supplies
3. ・Knowledge and skills training for healthcare workers
4. ・Supportive supervision
5. ・Data management reviews
6. ・Integrated outreach services
7. ・Household visits and capacity strengthening for CHVs
8. ・Formation and strengthening of M2M groups

2. Improving WASH Conditions and Hygiene Practices in Health Facilities and Communities

To reduce diarrhea cases among children under five, we provided WASH training and handwashing education for healthcare workers, CHVs and teachers, focusing on health facilities and schools. We also supported the introduction of water purification methods, implemented Community-Led Total Sanitation (CLTS) activities to address open defecation, and established Oral Rehydration Corners (ORCs)* at health facilities to provide appropriate care for children with diarrhea.

*Oral Rehydration Corner

Key activities

・Establishment of Oral Rehydration Corners at health facilities

・WASH training for teachers

・Establishment and training of school health clubs

・Training and monitoring to address open defecation

・WASH awareness-raising for community members

3. Improving Nutrition Practices among Community Members

We provided nutrition training for healthcare workers and CHVs, cooking demonstrations, and nutrition education through M2M groups, while promoting awareness of maternal and child health and nutrition. We also strengthened community- and facility-based screening and referral systems for the early identification and support of children with acute malnutrition.

Key activities

・Support for nutrition activities in M2M groups

・Nutrition screening for children under five

・Follow-up of children with acute malnutrition

・Nutrition training for healthcare workers and CHVs

4. Strengthening Governance for Maternal and Child Health

We promoted community-led advocacy through Citizen Voice and Action and worked with government stakeholders to influence policies and budgets for maternal and child health, nutrition and WASH. We also conducted project monitoring and evaluation, shared results, and held discussions to support the sustainability of project activities.

 

Key activities

・Community-led advocacy through Citizen Voice and Action

・Stronger collaboration with government stakeholders in MNCH, nutrition and WASH

・Support for participation in government policy and budgeting processes

・Sharing project results and discussing sustainability

・Regular dialogue between government and communities

・Project monitoring and evaluation

By improving the environment supporting maternal and child health services, educating and raising awareness in communities, and establishing community-led systems, the project contributed to changes in the use of health services, health practices and local implementation structures. The main changes over the three years are presented below with key indicators.

1. Improved Access to Maternal and Child Health Services

Improvements to health facilities, training for healthcare workers, community health education through M2M groups, and broader capacity strengthening made essential health services more accessible to pregnant women, mothers and children. Strengthening nearby facilities also helped distribute service users more evenly, reducing concentration at a single facility and enabling more women to receive appropriate care closer to home. Across Gilgil Sub-County, the under-five mortality rate decreased from 50 to 17 per 1,000 live births. The project contributed to this broader improvement in maternal and child health indicators.

*Affected by initial disruptions following the introduction of the Social Health Authority (SHA) in October 2024, shortages of healthcare workers, and insufficient staff housing.

2. Improved WASH Conditions and Hygiene Practices

Continuous awareness-raising in schools and communities improved hygiene practices and reduced diarrhea cases among children.

*Certification by government or other authorities that all households in a community use latrines and that open defecation no longer occurs.

3. Improved Nutrition Practices among Community Members

Nutrition training for CHVs and awareness-raising through M2M groups helped expand knowledge and practice of exclusive breastfeeding and appropriate complementary feeding. As a result, the number of underweight cases among children under five decreased.

4. Strengthened Governance for Maternal and Child Health

To support sustainability, we worked with Nakuru County, Gilgil Sub-County and local health personnel to foster local ownership. Counterparts are expected to continue and further develop the activities after project completion.

Voices of people involved in and benefiting from the project.

Voice from a Mother to Mother Group Supported by the Project

“I learned a lot from the M2M group. Knowledge about WASH and savings in particular was a real game changer for us. Women’s cash income has increased, enabling them to afford daily necessities. The number of children suffering from diarrhea has also decreased dramatically.”