Kenya's eCHIS: revolutionizing community health with digital innovation
Kenya has trained and equipped its newly professionalized CHWs with a new digital tool that is expanding access to health care, improving the quality of the health care provided, and delivering the data health leaders need for effective decision-making

Over the past year, the Kenyan government has rolled out a powerful digital tool that connects the country’s 106,000 community health workers (CHWs) with a centralized digital health system – giving national health leaders unprecedented visibility into health care data at the community level.
The electronic community health information system, or “eCHIS,” offers the country’s newly professionalized CHWs (called community health promoters in Kenya) support across a range of common challenges from case management and commodity management to data collection and processing. It is interoperable with other digital health tools across the Kenyan health system, supporting adherence to national reporting standards.
The eCHIS is the culmination of more than a decade of investments in community health digitization in Kenya. It was built to respond to serious gaps in community health service delivery, including poor quality and inconsistent community health data and reporting, inconsistent quality of care, and perennial stock-outs.
“Before this system, the numbers we received from communities didn’t add up,” said John Wanyungu, deputy head of the division of community health systems management at the national ministry of health. “They didn’t reflect reality. They would tell us the number of households who received services and when we analyzed their data, we would see that it wasn’t believable. It was something like 1,000% of households. This left the national ministry of health unable to engage in data-driven decision making.”
Previously, the community-level data supplied to the national government was not actionable, said Simon Mbae, program head for East Africa at Medic, a nonprofit that supported the development and implementation of eCHIS alongside a consortium of organizations called the CHU4UHC – Community Health Units For Universal Health Coverage. “You couldn’t track a patient or a household moving from the community to the health-facility level and back.”
The challenge reflected the reality on the ground – community health was a heavily siloed enterprise. For example, one NGO focused on malaria or immunization health services and might provide a digital tool and training to CHWs focused only on malaria or immunization. While another NGO might provide that same CHW with different training and a different device or health app to help them manage yet another health challenge or to manage supplies.
“Everything was done on a project-specific basis,” said Mbae. “And an app would become obsolete as soon as the NGO project was finished – nothing was long-term and broad-based. You can imagine what that looked like on a national level.”
The eCHIS initiative, rolled out in conjunction with new training, service delivery kits, and compensation for CHWs, is intended to transform what was a volunteer cadre of CHWs, who were seen as merely data collectors and providers of basic care, into a highly motivated, supported, professionalized, national workforce.
“The relevance and performance of CHWs has been transformed,” said Mbae. “CHWs are now seen as agents of change. They are not just people who generate data. They are providers who consume data.”
Wanyungu identified four key impacts of the initiative. First, CHWs are now guided by eCHIS in managing their time and their cases. “This means that CHWs can prioritize visits based on the health history of the household and be more efficient with their time,” he said Wanyungu, who added that based on the data CHWs enter, supervisors can see if they are reaching all the households in their catchment area. And supervisors can now identify and point out which households they are missing. The tool can help CHWs prioritize and plan their day and week, for example, by reminding them to follow up with a particular child who reported a fever two days ago.
Second, eCHIS has helped improve access to health services for households, said Wanyungu. This is because the system supports the registration of households for health services and supports referrals between health facilities and follow-up care. Third, eCHIS supports the standardization of health care protocols across counties and across the country by giving CHWs ready access to national guidelines of care, said Wanyungu. Fourth, he said, eCHIS has given health leaders on the national level their first access to reliable community-level health data to support evidence-based decision-making.
The eCHIS is an open-source digital tool powered by Medic’s Community Health Toolkit (CHT), which can be accessed with an ordinary smartphone. Outside of Kenya, 17 other countries are using CHT technology, with comparable eCHISs being implemented by national governments in Côte d'Ivoire, Mali, Nepal, Togo, Uganda, and Zanzibar. Medic worked in concert with Kenya’s ministry of health, leaders across all 47 counties (reflecting the devolution of the health system in Kenya), and the CHU4UHC to co-create the tool’s standardized features and functionalities.
The focus was to develop a tool that was intuitive and easy to use – especially given CHWs’ varying levels of digital literacy. Ease of use helped nudge CHWs towards adoption. So did incorporating the use of the tool into CHW performance metrics. Today about 90% of CHWs are using the tool regularly.
The tool was first piloted in 2022 in Migori County on the banks of Lake Victoria, where implementation challenges were identified and resolved over many months. By June 2023, the tool was in the hands of CHWs across four counties. In October of 2023, President William Ruto announced a national roll-out.
The eCHIS tool "rode a remarkable political upswing of interest and is the result of human creativity and collaboration, persistence and local leadership” said Dr. Krishna Jafa, the chief executive officer of Precision Global Health who formerly led Medic during the development and launch of eCHIS. “The pandemic had demonstrated the need for such a solution. So, everyone, from county governments up to staff in the ministry of health and the president’s office were committed and tracking the rollout closely.”
Lessons Kenya learned while rolling out the tool include the need for human-centered design. That means that the digital forms included in eCHIS are not simply a copy of the traditional paper forms and ledgers used by CHWs. Instead, Kenya co- created new digital forms in collaboration with CHWs, government health leaders, user-experience experts, and coders. “Human-centered design is both necessary and can be time-consuming,” said Dr. Jafa. “Sometimes you have to slow down to go fast.”
Wanyungu noted that health leaders need to be realistic about the resources required to launch such an initiative. This includes not only buying the phones, but also paying and training the CHWs and creating the first registry of CHWs so that they could be paid, laying hundreds of miles of fiber optic cables, buying the computer infrastructure for “nodes” in each county, as well as establishing the necessary human capacity in counties to maintain that physical infrastructure and the local capacity within county and national government to leverage and manage the eCHIS system.
“Today, the ministry of health can manipulate the dashboards,” said Mbae. “They have the technical knowledge to independently manage the system. And they have established a data-driven culture that is responding to the system.” This requires a large team, added Wanyungu. “We are a large team with a wide range of expertise,” he said. “We have financing experts, human resources experts, and so on. The full range of skills across the team is very important.”
The government has not yet conducted a cost-effectiveness assessment. But anecdotal evidence from some counties indicates that some of the costs incurred are offset by, for example, no longer printing and distributing paper medical forms to CHWs.
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