By Vicky Maiyo, Senior Program Officer, and Penina Onyango, Program Officer, MOMENTUM Routine Immunization Transformation and Equity

Carol Wanda is a registered nurse in Homa Bay County, Kenya. For 15 years, she worked at the medical ward at the county referral hospital, which is classified as a level-five health facility. This means that it offers comprehensive services that require specialized care, such as surgical procedures. County referral hospitals are typically in urban settings, receiving patients from inside and outside of the county. In October 2022, in an effort to balance staffing across facilities, Carol was transferred to Nyalkinyi Health Center, a level-three facility. At this level, staff offer a range of primary health care and preventive services, including routine immunization. Adequate staffing at level-three facilities is key to ensuring access to, and utilization of, immunization services.

Carol and the 11 other nurses who were transferred were expected to deliver services that were not offered at their former facilities. In her previous role, Carol did not administer vaccines, so she was unfamiliar with some immunization topics and developments, such as immunization schedules for newly introduced vaccines. She and the other nurses worried that the sudden shift in their responsibilities and lack of immunization experience would compromise the quality of care at their new health facilities.

To address these concerns, MOMENTUM Routine Immunization Transformation and Equity engaged the Ministry of Health Sub-County Health Management Team (SCHMT) in Homa Bay to convene a team of 12 experienced staff to mentor the nurses. MOMENTUM provided technical and financial support to the SCHMT to design and implement a mentorship tool. First, each transferred nurse was paired with an experienced mentor from the sub-county. The transferred nurses completed baseline assessments that revealed knowledge gaps in several areas of immunization, including how to store vaccines, maintain cold chain equipment, record and report data, and forecast vaccine supply.

Over three months, the mentors tailored their instruction to the needs of their mentees, focusing on the topics that they struggled with in the baseline assessment. Project staff and the SCHMT made regular visits to the lower-level facilities to help mentors conduct on-the-job training sessions and provided real-time feedback on their implementation efforts. They covered a range of topics, such as the current immunization schedules, data recording and reporting, immunization forecasting and supply chain, cold chain monitoring, and community engagement to generate demand.

To ensure routine services were not compromised, mentors and mentees agreed on a mentorship schedule that aligned with their work routines, typically choosing an afternoon on a less busy day at their facilities.

The mentorship prepared Carol, who scored 42 percent on her baseline assessment, for all stages of immunization, from community outreach planning to data reporting. When Carol retook the assessment after the training period, she scored 85 percent.

“Our immunization mentorship has really helped us and changed our attitudes. Now we have knowledge on immunization and how to involve the community,”  explained Carol.

This mentorship improved the transferred health workers’ knowledge, skills, and confidence. This enables Nyalkinyi Health Center to maintain high immunization performance, while staff can provide high-quality immunization services to the people who need them most. By assigning SCHMT staff as mentors, the project fostered government ownership of the process for lasting results. Implementation of the approach is flexible and can be adjusted to meet the needs and schedules of health care workers, which makes it a practical and sustainable strategy that can be replicated in a variety of settings.

With MOMENTUM support, the SCHMT continues to conduct supportive supervision visits and regular performance review activities to build health worker capacity in Kenya, focusing on the gaps that they identified through this mentorship process.