Indicators of SAMACH to be achieved by December 2026

• At least 80% of County Health Management Teams (CHMTs), Sub-county Health Management Teams(SCHMTs), and HFs made and documented evidence-based decisions every quarter for over a year (Baseline is Zero)
• At least 50% of Level 3 HFs are equipped with the full set of seven essential items required for delivery service with the support from CHMT/SCHMT (Baseline is
• At least 80% of Level 2/3 HFs have included and monitored three or more activities related to RMNCH and immunization in their AWP. (Baseline 17%, Sep 2025 51%)
• At least 70% of L2/3 HFs use R&E tool for accountability purposes. (Baseline is Zero)

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At least 80% of County Health Management Teams (CHMTs), Sub-county Health Management Teams(SCHMTs), and HFs made and documented evidence-based decisions every quarter for over a year

How to write in the column of　　　　　　　　　　　　　�6.1　What are 'the Way forward' Actions

Examples from the FIC

• Request for an additional nurse
• Provision of maternity equipment to improve service delivery. Timely payment of salaries to motivate staff
• launch initiatives to increase our workload by educating the public on sha registration and also encourage the chps to continue with the registration activity in the community

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The WAY FORWARD ACTIONS should be monitored and commented by the CHMT. If the ”SUBJECT/WHO does WHAT” is not clear, it is not possible to follow up.

At least 50% of Level 3 HFs are equipped with the full set of seven essential items required for delivery service with the support from CHMT/SCHMT

At least 50% of Level 3 HFs are equipped with the full set of seven essential items required for delivery service with the support from CHMT/SCHMT (Baseline5%, Nov 2025 36%)���

At least 80% of Level 2/3 HFs have included and monitored three or more activities related to RMNCH and immunization in their AWP.

Baseline 17%, Nov 2025 91% (60/66)

At least 70% of L2/3 HFs use the R&E tool for accountability purposes. (Baseline is Zero)��However, here, we measure for accountability process. Meaning we will see if it is properly used.��

Benefits of SAMACH Online Tools

AWP Online Tool

• Easier to create, update, and compare AWPs with previous years.
• Uses for appropriate budget allocation and helps HF to manage within the budget ceiling
• Helps facilities set realistic plans and monitor implementation.
• Helps FIC to know which activity to prioritize depending on the funds available.
• Regularly used during internal and JQRM meetings to track progress.

Model Activity List

• The Model Activity List assists in not forgetting the activities to enter into the AWP. It also helps in not putting the activities in the wrong subprogram and outcome.

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HR Tool

• Clearly shows staffing gaps and helps advocate for more staff (successfully used to request and secure additional staff in some facilities).

Equipment Tool

• Makes equipment needs more visible and easier to communicate within the HF.
• FIC uses the tool to lobby for needed equipment (e.g., delivery beds, fetal dopplers, lab refrigerators) to the Sub County Head and CHMT.

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R&E Tool

• Improves tracking and transparency of funds received and spent.
• Supports smooth financial handover when FICs are transferred.
• Currently captures funding from DANIDA and SHA.

Joint Review Meetings

• Strengthened collaboration between FICs, SCHMT, and CHMT.
• Enhanced peer learning through sharing of good practices among HFs.
• Improved accountability as FICs present progress and provide feedback to facility staff.

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Kindly make sure that more than ONE person knows how to use the tool.

Good Practices in MCH Services

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1. Health Education and Sensitization
1. Posters and visual materials are displayed in Health Facilities (HFs) to inform clients about available services.
2. Regular community meetings (barazas), outreaches and Mother’s Day events help raise awareness on safe pregnancy and MCH services.
3. The HF is building a strong relationship with the catchment population by offering health education during community meetings led by the area Chief and outreaches.
2. Monitoring and Client Feedback
1. HFs conduct monthly meetings to review progress on the Annual Work Plan (AWP) and address client issues. 
2. The HF conducts client exit interviews and has a complaints register book to gather feedback to improve services. 

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3. Management and Staff Training 
1. Standard Operating Procedures (SOPs) are available in departments to improve standardization and clarity of roles. 
2. Nurses regularly educate other health staff, including training on client-friendly attitudes.

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ANC

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1. Health Education and Sensitization
1. HFs provide daily health talks covering the importance of ANC services and the benefits of early attendance. 
2. Community Health Promoters (CHPs) conduct community-level sensitization to raise awareness about ANC services among pregnant women and their families. 
3. The Facility in Charge (FIC) encourages pregnant women to attend up to eight (8) ANC visits.

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2. Service Efficiency
1. Staff from non-MCH departments assist with ANC services (e.g., support staff are assigned duties such as managing the triage area).
2. The nurse ensures proper stock management of ANC reagents or ample supply (e.g., Iron, Folic Acid).
3. The ANC profile is initiated immediately after a positive pregnancy test, and staff explains the importance of receiving ANC services.
4. The nurses educate all the staff on the utilization of the Maternity Ward and on attitude to pregnant women.

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3. Prioritization of Pregnant Women coming for ANC visits
1. Pregnant women are prioritized to reduce waiting time (e.g., separate waiting areas and identification using ANC booklets).

4. Continuity of Care and Follow-up
1. Pregnant women receive the dates for the next visit before leaving the HF.
2. Follow-ups are conducted through phone calls by health staff or home visits by CHPs if appointments are missed.

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Delivery Services

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1. Health Education and Sensitization
1. Posters and visual materials are displayed in Health Facilities (HFs) to inform clients about delivery services.
2. Nurses educate pregnant women and family members, especially husbands, on birth preparedness during ANC visits and community meetings.
3. The HF conducts delivery room tours for pregnant women to reduce their anxiety.

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2. Service Efficiency

1) Facility Environment

• Delivery rooms are improved (e.g., hot showers, curtains) to ensure comfort and privacy. 

2) Staff Training  

• Staff receive training in emergency preparedness and teamwork to manage safe deliveries.
• Continuous Medical Education (CMEs) are held to train the health staff in delivery care.

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3) Referral Networks   

• Regular nurses’ meetings in the Sub-County (SC) strengthen referral mechanisms within the SC which increases deliveries in the HCs.
• Liaising with nurses from nearby dispensaries to have their ANC clients deliver in their HFs.
• Monthly meetings with CHPs help strengthen the referral system.

4) Incentives

• HFs provide “Mama packs” or “Infant packs” to mothers after delivery.
• Meals are provided for mothers after delivery.  
• Clients can contact families via HF phones after delivery.

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3. Continuity of Care and Follow-up 
1. The FIC encourages pregnant women during ANC visits to deliver at the HF.
2. Pregnant women in their third trimester are booked for delivery.
3. Health staff call or send Short Message Service (SMS) to the pregnant women before their due dates to encourage delivery at the HF.

4. Data Management 

• Installation of Electronic Medical Records (EMRs) has improved accuracy in capturing the number of deliveries

PNC

1. Health Education and Sensitization
1. The HF sensitizes clients on the importance of PNC visits during their ANC visits or delivery stay.
2. Service Efficiency
1. Service Delivery
1. PNC services have been expanded to six (6) visits at 6, 10, 14 weeks, and 4, 5, 6 months (previously only four (4) visits).
2. Staff are courteous and supportive to mothers.
3. Staff from non-MCH departments assist PNC services.
4. Mothers can access both services during a single visit because PNC services and Child Welfare Clinic (CWC) services are integrated.
5. A separate room for CWC and Immunization has been constructed to reduce waiting times for mothers who come for PNC visits.

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2) Incentives

• HFs provide mosquito nets to PNC clients.

3. Continuity of Care and Follow-Up 
1. Mothers are booked for the next appointment before leaving the HF.
2. Follow-up for mothers, including those who delivered in other places, is conducted through home visits and phone calls for continuity of PNC visits.  
4. Data Management
1. Installation of EMRs has improved accuracy in capturing client visits.

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Facility Improvement Funds (FIF) Utilization

The following are the planned areas for its utilization:

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• Payment of casual workers’ wages and utility bills
• Construction (e.g., triage area, patient’s waiting area, maternity ward, toilets)
• Maintenance of the HF (e.g., repainting, tiling, sink repair) and the medical equipment (e.g., autoclave, monitor machine for checking client’s vital, oxygen gauge)
• Procurement of laboratory equipment (e.g., hemogram machine), medical equipment (e.g., diagnostic sets and nebulizers)

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• Set up a drainage gutter for water harvesting
• Purchase of Kenya Expanded Program on Immunization (KEPI) gas and cooking gas
• Purchase of office equipment and furniture
• Purchase of cleaning materials
• Wiring for network connectivity
• Transport for activities such as school health outreaches
• Payment of board allowances to the Health Facility Management Committee (HFMC) members
• Provision of tea and snacks to the staff and patients

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