1. The document describes a program to improve birthing health in Mukuru, Kenya, a slum area with high HIV rates and poor access to resources. 2. The program will train community health workers and doulas to provide outreach on proper drug adherence and birthing kits. It will also establish community support groups and counselors. 3. Clinics will be upgraded based on birthing center standards and a network will be created for collaboration and data sharing between clinics. The program aims to scale to other slums over 3 years then transition to government management.

1. Birthing Healthy
Babies, Mukuru,
Kenya
Alexis Coppola - Kate Jackson - Amihan
Jones - Apostolos Kalantzis

2. MUKURU
○ 600,000-700,000 residents in 8 sub villages
○ Slum area in industrial Nairobi
○ Lack of electricity & water
○ HIV rate is 10%
○ Half the population is under age 15
○ 16 clinics: already working on HIV related initiatives

3. Problem Tree

4. Results Framework

5. Components

6. Community-Level Programmatic
Activities
1. Community Health Worker program (CHW)
○ Design of the CHW curriculum and tools
○ Members of the community and doulas are trained in outreach
services, as well as proper adherence to AZTs
○ Doulas receive Doula kits (birthing kits complete with nutritional
supplements)
2. Community Groups
○ Community mother support, theatre, and radio groups
3. Counselors
○ Community counselors trained
*AZT regiment that we are basing programming around is oral medications 2
weeks before due date and every 3 hours during labor

7. Clinic-Level Programmatic Activities
1. Clinic upgrades
○ Create standards for birthing centers
○ Needs assessment of birthing centers
○ Assess needs with funding and make 3 year plan
2. Create network clinics for collaboration and data sharing
○ Qualitative work
○ Stakeholder engagement and input
○ M & E
○ Sustainability
○ Management training of clinic professionals

8. Cross-Sector
1. SMS mother reminder system:
○ Paper-based registration process
○ CHW's uses a guided questionnaire to be put into a central database
○ Information to be collected: mother , phone , days since last menses
○ Kenyan Gov pays for incoming messages; Safaricom pays for
outgoing messages
○ Mother's receive text messages about proper drug adherence

9. Government-Level Programmatic
Activities
○ Advocate for subsidized cost of AZT drugs
○ Govt distribution of AZT drugs
○ Reduced tax/free incoming SMS messaging
○ Support of central healthcare database system

10. Scale, Sustainability & Exit
Scale:
1. 3-year pilot for can work in other slums
2. M&E will determine programmatic activities that need redesign
Exit: (Phase Down & Phase Over)
1. Government handover (including server for SMS-entire SMS system at the ministry)
a. Government of Kenya will manage CHWs
b. All programmatic activities will be developed as a collaborative undertaking between
government of Kenya, UNICEF, and Birthing Healthy Babies and USAID (CDC) and
will be handed over to the government after a 3-year period
2. Community handover
a. Training
b. Clinic healthcare network
c. Community groups
Sustainability:
1. Project has been designed with collaboration as a main component
2. Project has been designed to work off of already infrastructure and community resources

11. 1. Name and number of Strategic Objective: SO1: Improved prevention of mother to child HIV transmission
2. Name and number of Intermediate Result: IR1: Improved child feeding practices for mothers with HIV
3. Indicator (state in QQTP terms): An 80% increase in HIV positive mothers in Mukuru exclusively abstaining from breastfeeding
over the next 3 years
Is this an Annual Report indicator? Yes
5. Precise definitions of terms included in the indicator:
HIV positive mothers: mothers that have tested positive for HIV
Abstaining from breastfeeding: mothers who are 100% abstaining from breastfeeding any child
6. Unit of measure: % increase of HIV positive mothers in Mukuru exclusively abstaining from breastfeeding
7. Disaggregated by gender, HIV status, mother
8. Indicator Justification and Management Utility: The abstention of breastfeeding of HIV positive moms is proven to reduce
MCT transmission.
9. Data collection method: Surveys, individuals interviews, and clinic records
10. Data source: Internal data collected through surveys and individual interviews conducted by community healthcare workers
and aggregated data from clinic records
11. Data analysis: Aggregate and analysis quantitative and qualitative data in SAS and MaxQDA
12. Presentation of Data:Annual report, charts and PowerPoint presentation
13. Review of data (how and by whom will data quality be safeguarded?):
Survey information will be collected by healthcare workers (anonymous).
Data will be collected and aggregated by organization
14. Reporting of data (how, by whom and to whom will data be reported?):
In an annual report and through in-person presentations, by non profit organization to all stakeholder groups, including clinicians,
community healthcare workers, the Government of Kenya and Safaricom

12. 1. Name and number of Strategic Objective: SO1: Improved prevention of mother to child HIV transmission
2. Name and number of Intermediate Result: Increased HIV testing women and mothers
3. Indicator (state in QQTP terms):
100% increase in pregnant women in Mukuru being tested by a healthcare worker over the next 3 years
4. Is this an Annual Report indicator?
Yes
5. Precise definitions of terms included in the indicator:
Pregnant: all pregnant women
being tested: given an official standard HIV test
healthcare worker: an employee or volunteer of a clinic that is certified to administer HIV testing and counseling
6. Unit of measure: % increase of pregnant women in Makuru that are tested for HIV by a healthcare worker
7. Disaggregated by: gender, location, pregnancy status, HIV status
8. Indicator Justification and Management Utility:
The testing of HIV positive moms leads to improved practices to reduce MCT transmission.
9. Data collection method: Surveys, individuals interviews, and clinic records
10. Data source: Internal data collected through surveys and individual interviews conducted by community healthcare workers and aggregated data from clinic records
11. Data analysis: Aggregate and analysis quantitative and qualitative data in SAS and MaxQDA
12. Presentation of Data: Annual report, charts and PowerPoint presentation
13. Review of data (how and by whom will data quality be safeguarded?):
Survey information will be collected by healthcare workers (anonymous).
Data will be collected and aggregated by organization
14. Reporting of data (how, by whom and to whom will data be reported?):
In an annual report and through in-person presentations, by non profit organization to all stakeholder groups, including clinicians, community healthcare workers, the Government
of Kenya and Safaricom

13. 1. Name and number of Strategic Objective:
SO1: Improved prevention of mother to child HIV transmission
2. Name and number of Intermediate Result:
Increased access to AZT drugs for mothers with HIV
3. Indicator (state in QQTP terms):
100% increase in HIV positive pregnant women in Makuru receiving AZT treatment from a healthcare worker, 2 weeks before due date or every 3 hours during delivery over the next 3 years
4. Is this an Annual Report indicator? YES
5. Precise definitions of terms included in the indicator:
HIV positive pregnant women: all women that have tested HIV positive and are pregnant
receiving AZT treatment: has been provided AZT and drug information, as well as adherence consultations
healthcare worker: an employee or volunteer of a clinic that is certified to administer HIV testing and counseling
6. Unit of measure: % in of HIV positive pregnant women in Makuru receiving AZT treatment
7. Disaggregated by: Gender, HIV status, Pregnancy Status, Location
8. Indicator Justification and Management Utility: The use of AZT of HIV positive moms during labor is proven to reduce MTC transmission.
9. Data collection method: Surveys, individuals interviews, and clinic records
10. Data source: Internal data collected through surveys and individual interviews conducted by community healthcare workers and aggregated data from clinic records
11. Data analysis: Aggregate and analysis quantitative and qualitative data in SAS and MaxQDA
12. Presentation of Data:Annual report, charts and PowerPoint presentation
13. Review of data (how and by whom will data quality be safeguarded?):
Survey information will be collected by healthcare workers (anonymous).
Data will be collected and aggregated by organization
14. Reporting of data (how, by whom and to whom will data be reported?):
In an annual report and through in-person presentations, by non profit organization to all stakeholder groups, including clinicians, community healthcare workers, the Government of Kenya and Safaricom