Digital data linkage and scheduling to track pregnancy (‘C-it’) with or without community data use (‘C-it DU-it’) to increase antenatal clinic uptake in western Kenya:a cluster randomised trial

Facility and community health data is being rapidly digitised using multiple parallel systems across the 47 devolved counties in Kenya, but data do not link. Setting up community-based antenatal care (ANC) to complement facility-based ANC and data systems that link these platforms is essential to support Kenya in adopting WHO’s ambitious target of 8 ANC contacts. As of February 2023, national scale up of the national electronic community health information systems (eCHIS) for standard of care is ongoing, and there are increased efforts to scale-up use of the nationally approved Kenya ElectroniMedical Records (KenyaEMR) Maternal and Child Health Module (MNH) to capture ANC, delivery and postnatal (PNC) data at health facilities. Data between eCHIS and Kenya EMR do not link. There are plans within the Community Health Division at national level to link eCHIS to facility EMRs, but this has yet to be developed.We propose to increase ANC uptake through a health systems strengthening approach that links digital data platforms and trains community Work Improvement Teams (WITs) to use these data to identify problems and come up with local solutions. The research question we will seek to answer is “what is the effect of ‘C-it DU it’ on community health systems strengthening and what is required for effective transfer and scale-up?” We will use mixed methods implementation research to evaluate this in 4counties in Western Kenya (Homa Bay, Migori, Kisumu, Kakamega) over a period of four years.