TIST: Rising carbon price enables more rapid growth of TIST tree growing in Africa and India
Growth of TIST’s pro-poor tree growing activities in sub-Saharan Africa and India has been held back in the past by the low price paid in the informal carbon market for its “high quality” carbon credits. The greater recent awareness of the need to act to address climate change has led to a large increase in 2020 in the price paid to purchase TIST’s carbon credits. The resulting increase in resources has enabled TIST to adopt a more ambitious expansion plan aimed at substantial further increases in the currently 90,000 farmer beneficiaries and the currently 18 million trees grown.
Changing the Forecast for 2030
In February, the UN launched its Global Estimates of Maternal Mortality report for 2010-2020, presenting both a sobering view of the past decade and a grave forecast for SDG 2030 targets. Jacaranda commit to breaking this cycle by scaling solutions that not only work to improve quality in the here and now, but embed within government health agendas and budgets in the long-term. The work you’ll read about in their Q1 Impact Report speaks to this - from expanding a data-driven approach to ensure respectful maternity care, to defining ‘exemplars for quality’ in hospitals and health systems, and making deep user-centered research the foundation of program design.
AMPLIFYING MOTHER’S VOICES: A data-driven approach to ensuring respectful care for mothers. If women find themselves mistreated, they have two options: seek health services elsewhere or don’t seek care at all. Respectful care is paramount to timely, quality care, but in Kenya, few formal channels exist for mothers to share feedback. Each month, mothers receive an SMS from Jacaranda's digital health tool PROMPTS asking them to share whether they were treated with respect during their facility visits. They are asked to explain instances of disrespectful care, helping pinpoint the often-invisible issues hindering care provision. In Q1, they rolled out new Quality of Care dashboards, consolidating data from millions of mothers’ experiences with data from facilities to help nurses and their managers rapidly identify the drivers of poor quality care - from skills gaps and stock-outs to disrespectful care. Traffic light coding helps easily and routinely identify gaps, from issues of privacy, poor communication or confidentiality breaches, to instances where care is refused or held back. Over the coming months, they will closely monitor uptake and use of these dashboards among their government partners - with the hope that ‘client-side’ data becomes a driving factor in ensuring all mothers receive dignified care during and after pregnancy.
Data dashboards for dignified care. – When the in-charge at a Nairobibased facility noticed reports of mothers being turned away from prenatal care, she called an urgent meeting. It was quickly apparent that while her colleagues were keen to offer services to all mothers in the waiting room, poor scheduling, heavy workloads, and patients turning up outside hours meant it wasn’t always possible. New measures have since transformed their capacity to offer services, including time management training, streamlined service delivery across, posters in the waiting areas indicating service times, and new ticketing systems.
EXEMPLARS FOR QUALITY: How rethinking Kakamega’s hospitals and health systems could define new standards of care for the future. H.E. Hon. FCPA Fernandes Barasa, OGW Governor of Kakamega County, Chairperson Finance, Planning and Economic Affairs Committee (CoG) recently announced 'My intention and that of our partners is to redesign how we offer health services to ensure that expectant mothers and other members of our community access facilities with competent medical personnel and appropriate equipment as quickly as possible',
Poor quality care is a complex, cross-sectional issue, but too often its drivers are dealt with in silos. In March, Jacaranda representatives joined Kakamega’s Governor and County Health Management teams to launch Tutunze Kakamega, a crosssectoral strategy that tests how to improve maternal and newborn survival by shifting where and when mothers access care. Since 2019, Jacaranda and a coalition of local partners have supported Kakamega’s government to expand the capacity of delivery services in hospitals while improving the quality of antenatal and postnatal care in clinics. Malava Sub-County Hospital is the first of a number of Kakamega’s hospitals to welcome an increased volume of deliveries in line with the shift. Its capacity will be routinely assessed against new ‘Facility Readiness’ standards, which take into account a range of factors influencing services - financing, staff, equipment, beds and medicines - to consistently ensure the best possible outcomes in even the most complex of cases.
Behind every safe delivery is a set of co-dependent drivers that ensure mothers get timely, quality care. Between October 2022 and February 2023, we saw notable improvements at Malava Sub-County Hospital. 1 new maternity wing, with an equipped delivery room, maternity & newborn units. 21% increase in staffing, including new pediatricians and anesthetists. 57% increase in available essential commodities for mothers and babies.
A DEEPER DIVE How research is helping us to unearth answers to the critical questions facing mothers and babies today.
Research is the backbone of design. It ensures Jacaranda's innovations continue to reach the evolving needs of those they serve, and serve as sustainable solutions to the pressing issues facing mothers in government health systems. Their research capacity continues to grow, in Q1, otheir Research, Design & Evaluation team, including data analysts, field researchers, and biostatisticians, reached double figures. The same quarter saw the completion of data collection and preliminary analysis of a large-scale Randomized Control Trial, led by independent evaluators at Harvard University, with data collection completed by IPA, to generate deeper, cross-cutting insights into the impact of their programs. They also forged new research partnerships to answer some of the critical questions in maternal and newborn health today.
DATA SNAPSHOT Putting mothers in the driving seat of defining and reporting on technical quality.
The thousands of daily interactions we have with mothers on PROMPTS helps inform the clinical quality of prenatal care. Prenatal check-ups help ready women for birth and spot early signs of complications but, across Kenya, their quality varies by facility. After each check-up, mothers are asked whether the appropriate clinical steps were taken using a simple ‘yes/no’ SMS format. ‘Was your blood pressure taken?’, ‘Did you discuss labor signs?’, This feedback helps health system managers track and standardize the clinical quality of prenatal care across the facilities they manage, and dig into issues, from informational gaps (eg. birth plan), to systemic gaps like medicine stock-outs or equipment shortages. It also gives mothers the confidence to demand the right care. A nurse incharge recently remarked to a member of our field team that their clients now actively request certain services - during their prenatal care visits as a result of PROMPTS messages.
EMBRACING #DigitALL FOR INTERNATIONAL WOMEN'S DAY
On March 8th, Jacaranda joined the world in celebrating digital equity, the theme for this year’s International Women’s Day. The theme felt acutely relevant to the work they’re doing now; exploring participatory approaches to digital design, testing alternative means to reach ‘last mile’ mums through PROMPTS, and translating women’s voices into actionable data for governments. Jacaranda's 2025 Strategy looks to make inclusive digital tools a driving force behind better maternal and newborn health outcomes - empowering women to confidently navigate the health system and fortifying the frontline health workforce to ensure they receive quality, dignified care.
A comparison of strategies to improve uptake of COVID-19 vaccine among high risk adults in Nairobi Kenya was carried out in 2022.
Background: COVID-19 vaccine uptake in Kenya is still low compared to other countries, especially in Europe and North America. In most parts of the country a large percentage of the Kenyan population remains unvaccinated. As of October 2022 the Ministry of Health (Kenya) estimates that only 36.2% of the adult population had been fully vaccinated.
Methods: Penda conducted an experimental study in April 2022 targeting unvaccinated adults who had a history of typertension and/or diabetes and those in the 60+ age group. They tested various messaging approaches using two different intervention channels.
Results: Although the overall rate of vaccinated individuals according to national records is low, responses from the study group collected through phone call coversations show that higher-risk adults such as those older than 60 or those with chronic illnesses have a remarkably high vaccination rate of 89%. After the study, four participants received a COVID-19 vaccine within 1 month of the intervention. These four participants all received a loss-messaging intervention approach during the study.
Conclusion: The study supports a national approach to increasing COVID-19 vaccination rates using loss-messaging directed at unvaccinated high-risk individuals.
The full study and it's findings can be accessed in the attached file.
EfD are delighted to share the great news that one of the largest health insurance companies in Kenya has awarded Penda with the Excellence in Quality award. In the ceremony, they highlighted that Penda's Clinical Decision Support System (CDSS) is an example of what all the other healthcare providers in Kenya should be doing to improve quality in healthcare.
Thanks to EFD’s financial support, Penda has one of the most advanced CDSS in East Africa, guideline-based care using clinical decision support pathways, created using internationally recognized and standardized World Health Organization algorithms to recognize warning signs, diagnose, treat, and follow up prioritized primary care conditions. More than 90% of clinical encounters at Penda use CDSS, the core of clinical operations at Penda and the key to how they provide high quality care at low-cost.
EfD are looking forward to supporting Penda to develop their CDSS capabilities further to encompass the unique needs of Pigia Penda - their telephone-based healthcare delivery channel bringing remote primary care to low-income, hard to reach remote communities, expanding access and lowering costs to patients.
here is Doctor Robert Korom, Chief Medical Officer, receiving the Excellence in Quality award where he thanked to Penda's Quality team, IT team, Partnerships team, and Medical Centre teams.
TIST is The International Small Group and Tree Planting Programme. They are based in Kenya, Tanzania, Uganda with 136,100 farmers in 23, 610 small groups growing over 23,600,900 trees and to date, capturing over 9,000,000 metric tonnes of carbon!
Every month the various TIST groups let you know what they are doing and the benefits to the farmers and planet, you can hear their stories here
Jacaranda strengthens collaboration with National Government partners to scale solutions across Kenya ¬