The document outlines a program to improve birthing outcomes in Mukuru, Kenya. Mukuru is a slum area outside Nairobi with high HIV rates and lack of basic services. The program includes: 1. Training community health workers and doulas to provide outreach on proper drug adherence and birthing kits. 2. Establishing community support groups for mothers. 3. Upgrading local clinics and creating a network for collaboration. 4. Developing an SMS system for medication reminders managed by the government after 3 years.

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

2. MUKURU
o 600,000-700,000 residents in 8 sub-villages
o Slum area in industrial Nairobi
o Lack of electricity & water
o HIV rate:10%
o Half the population is under the age of 15
o 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)
o Design of the CHW curriculum and tools
o Members of the community and doulas are trained in outreach
services, as well as in proper adherence to AZTs
o Doulas receive Doula kits (birthing kits complete with nutritional
supplements)
2. Community groups
o Community mother support, theatre, and radio groups
3. Counselors
o Community counselors trained
*AZT regimen that was used to design programmatic activities is oral
medications that are taken 2 weeks before due date and every 3 hours
during labor

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

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

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

10. Scale, Sustainability & Exit
Scale:
1. 3-year pilot with the possibility of scale up in other marginalized communities
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, Birthing Healthy Babies, and USAID (CDC)
c. Program 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