Feasibility Study of the Project: “M-AFYA 2.0 – Mother-Led Digital Health for Resilient and Underserved Communities” Full Time NEW

Feasibility Study of the Project:

“M-AFYA 2.0 – Mother-Led Digital Health for Resilient and Underserved Communities”

(Turkana and Marsabit Counties, Kenya)

1.0 Background

Malteser International (MI) is the worldwide relief agency of the Sovereign Order of Malta that has for over 60 years provided relief and recovery during and following conflicts and disasters. MI also works alongside vulnerable communities on long-term programs to deliver lasting change. Christian values and humanitarian principles form the foundations of our work: bringing aid to people regardless of their religion, background, or political convictions at over 100 Projects in more than 20 countries. MI’s vision is a life in health and dignity for all; its mission is to provide emergency relief in crises such as natural disasters, epidemics, or armed conflicts and carry out programs that enable people transform their lives for the better. The approach is to protect health by ensuring people have access to functioning medical structures, adequate nutrition, clean water, sanitation, and hygiene as well as strengthen the resilience of people in especially vulnerable regions against future crises.

“M-AFYA 2.0 Project”

The “M-AFYA 2.0 Project” is a planned three-year initiative to be submitted to the German Federal Ministry for Economic Cooperation and Development (BMZ PT) through MI. Building on the success and lessons of the M-AFYA 1.0 Project implemented in Embakasi Sub-County, Nairobi (2015-2017), the new phase aims to strengthen access, quality, and continuity of maternal, newborn, and child health (MNCH) services in fragile and hard-to-reach settings of Turkana and Marsabit Counties in northern Kenya. The project will leverage digital innovations, including an upgraded M-AFYA platform integrated with the national e-Community Health Information System (eCHIS), to enhance early identification, referral, and follow-up of pregnant women and newborns. By strengthening linkages between households, community health professionals (CHPs), and primary health facilities, M-AFYA 2.0 seeks to reduce preventable maternal and neonatal deaths while promoting equity, accountability, and data-driven decision-making in ASAL contexts. The project ultimately aims to contribute to the reduction of maternal mortality rates in Turkana and Marsabit Counties, aligning with Kenya’s Vision 2030 and the national goal of lowering the Maternal Mortality Ratio to below 150 per 100,000 live births by 2030.

2.0 Rationale of the assignment

Despite national progress in reducing maternal and newborn deaths, Kenya continues to face unacceptably high mortality rates, with the maternal mortality ratio estimated at 355 deaths per 100,000 live births and the neonatal mortality rate at 21 per 1,000 live births (KDHS, 2022). These national averages mask significant sub-national disparities, with fragile and marginalized counties such as Turkana and Marsabit recording some of the poorest RMNCAH indicators. Limited access to quality maternal and newborn services, inadequate referral systems, and persistent health workforce and infrastructure gaps continue to drive preventable mortality in these regions. Addressing these inequities is therefore essential for strengthening resilience and advancing Universal Health Coverage (UHC) in Kenya’s arid and semi-arid lands (ASALs).

Women and newborns in these regions face multiple and overlapping vulnerabilities including long distances to health facilities, limited emergency transport options, weak referral linkages, and poor financial preparedness for health expenses. While Kenya has made commendable progress in strengthening its digital health architecture through the national electronic Community Health Information System (eCHIS), the benefits of these investments have yet to fully reach the most remote and marginalized households.

The proposed initiative builds on the evidence and lessons from M-AFYA 1.0, implemented by MI in Nairobi’s informal settlements between 2015 and 2017. The pilot combined digital technology, financial access, and community engagement to strengthen the continuum of maternal and newborn care. It introduced a mobile-based maternal health application that enabled pregnant women to register for antenatal care, receive automated reminders and health education messages, access emergency referral support, and use a digital health wallet linked to micro-savings groups to cover maternity-related costs. Results showed improved early ANC attendance, increased skilled birth deliveries, and enhanced coordination between community health volunteers and facilities. The pilot demonstrated that simple, low-cost digital tools can empower women, promote accountability, and improve health outcomes when integrated with existing service delivery systems.

Building on these results, the second phase, M-AFYA 2.0: Mother-Led Digital Health for Fragile Settings seeks to adapt and expand the approach to pastoralist and remote communities in Turkana and Marsabit Counties. Unlike the first phase, M-AFYA 2.0 will not introduce a new digital platform. Instead, it will focus on integrating and strengthening existing national and county systems, particularly the interoperability between eCHIS, health-facility digital records, and County Emergency Operations Centres (EOCs) to enhance coordination, accountability, and timely emergency response. The approach will also introduce an improved mother-led digital health wallet, designed to promote financial preparedness for maternal health expenses while reinforcing household resilience.

By embedding these functions within existing government structures, M-AFYA 2.0 aligns with Kenya’s UHC and Social Health Insurance Fund (SHIF) agenda, including the recently rolled-out Taifa Care under the Social Health Authority (SHA). This alignment ensures sustainability and government ownership from the outset. Given the complex socio-economic and geographic realities of Turkana and Marsabit, a feasibility study is required to assess the technical, institutional, financial, and social viability of the proposed integrated model.

The study will explore the following aspects:

1. System readiness for integration with SHIF, Taifa Care, eCHIS, and County EOC infrastructure, in line with national EMR interoperability efforts.
2. Capacity of county and community health systems to operationalize mother-led digital referrals, alerts, and linkages with health facilities.
3. Digital access and literacy levels among mothers and households, including availability and usability of digital devices, network connectivity, and readiness to adopt mobile-based tools.
4. Financial inclusion potential and local acceptability of the proposed digital health wallet.
5. Community and expectant mothers’ acceptance, usability, and behavioral feasibility of the integrated mother-led digital health model.
6. Pathways for long-term sustainability and scale within county and national health structures.

Findings from the study will inform the final project design and BMZ proposal submission, ensuring that M-AFYA 2.0 is contextually grounded, system-aligned, and positioned to deliver measurable improvements in maternal and newborn health outcomes in Kenya’s most fragile settings.

3.0 Scope of the Assignment

Guided by MI’s Program Team, the consultant will undertake a comprehensive feasibility study to assess the practicality, effectiveness, efficiency, and sustainability of implementing the proposed M-Afya 2.0 initiative. The assignment will operationalize the feasibility dimensions required under the BENGO guidelines that are technical, financial, institutional, and socio-cultural focusing on how the project can be effectively integrated within existing health systems.

Unlike M-Afya 1.0, this phase will not introduce a new digital platform but proposes to integrate key features and lessons learned by strengthening interoperability between existing systems such as eCHIS, health facility digital records, Taifa Care, EOCs, and other ongoing county or national digital health initiatives. The feasibility study will include both desk reviews and field assessments in Turkana and Marsabit Counties, complemented by validation workshops to ensure contextual alignment, government leadership, and stakeholder ownership.

Specifically, the consultant will:

1. Assess demand and potential impact of the proposed M-Afya 2.0 project within targeted health facilities and communities, focusing on how the integrated approach can improve access to and quality of maternal, newborn, and emergency health services.
2. Analyze available and required resources (financial, technical, human, infrastructural, and policy-related) for effective implementation, identifying opportunities to leverage existing county and partner investments. The analysis should also examine institutional and financial mechanisms that can support long-term sustainability, including potential integration into county health budgets, digital health frameworks, and national financing mechanisms such as SHIF/Taifa Care.
3. Identify potential challenges, risks, and mitigation measures related to digital integration and interoperability between eCHIS, health facility, and EOC systems. This should include a review of user capacity, digital literacy, and access to community-level hardware (e.g., mobile phones, tablets, or shared digital devices), as well as factors influencing community adoption, contextual content delivery, and long-term system maintenance.
4. Assess readiness and capacity of key health actors i.e CHPs, facility staff, Sub-County and County Health Management Teams, and ICT units to adopt, implement, and sustain the digital solution, including technical support, supervision, and reporting structures.
5. Map key stakeholders and existing digital health initiatives in Turkana and Marsabit Counties to identify collaboration, integration, and learning opportunities that can enhance efficiency, reduce duplication, and strengthen alignment with government-led systems.
6. Evaluate community perspectives and readiness for digital MNH solutions through consultations with pregnant and lactating women, CHPs, and community leaders to ensure that the design is user-friendly, culturally appropriate, and responsive to local needs.
7. Facilitate stakeholder engagement and validation workshops in Turkana and Marsabit to review preliminary findings, gather inputs, and build consensus on feasibility and design recommendations for M-Afya 2.0.
8. Recommend a scalable implementation and sustainability model, outlining key enablers, resource needs, partnership structures, and risk mitigation strategies to guide MI and county governments in decision-making for subsequent phases of the project.

Key Considerations

1. The feasibility study should provide a comprehensive contextual analysis of the proposed M-Afya 2.0 initiative at micro, meso, and macro levels, integrating essential and up-to-date data on the maternal, newborn, and adolescent health situation in Turkana and Marsabit Counties. This includes demographic trends, service delivery bottlenecks, and digital health readiness among both health providers and community members.
2. The assessment should include a critical examination of the project design and approach against the OECD DAC criteria on relevance, coherence, effectiveness, efficiency, impact, and sustainability. The consultant should assess both the digital health and financial empowerment dimensions of the M-Afya model, highlighting their contribution to improved MNH outcomes and system strengthening.
3. The feasibility study should explicitly analyze how digital integration and interoperability can be achieved between eCHIS, health facility electronic medical records (EMRs), EOCs, and national platforms such as Taifa Care and SHIF under the Social Health Authority. This includes identifying existing data exchange protocols, potential integration challenges, and opportunities to align with national digital health strategies and county ICT frameworks.
4. Community digital literacy, access to devices, and user acceptance should be examined as part of socio-cultural feasibility. The study should assess the availability and accessibility of mobile phones, tablets, and other digital tools among CHPs and mothers, barriers to use, and culturally appropriate strategies for community engagement and adoption.
5. The consultant should provide evidence-based recommendations for the technical, financial, institutional, and socio-cultural feasibility of M-Afya 2.0, including a proposed implementation roadmap that outlines integration pathways, capacity-building needs, and sustainability mechanisms through county ownership and financing.

4.0 Implementing partners

The feasibility study will be implemented under the overall leadership of MI, which will provide technical oversight, methodological guidance, and quality assurance in line with BENGO and OECD DAC requirements. MI will work closely with the Africa Inland Church Health Ministries (AICHM) as the local implementing partner. AICHM is an established faith-based health service provider with a well-established operational presence in both Turkana and Marsabit Counties, managing nine health facilities in Turkana and four in Marsabit. This extensive footprint and experience in community health programming make AICHM a strategic partner for supporting field coordination, stakeholder engagement, and access to community-level data during the study. It’s ongoing collaboration with county governments and deep-rooted community trust position AICHM to effectively facilitate local consultations, validation workshops, and data collection activities.

The project will also engage the County Governments of Turkana and Marsabit particularly their respective Departments of Health to ensure alignment with the Ministry of Health’s Digital Health and Community Health Strategies, including the integration of eCHIS and Emergency Operations Centres (EOC). As part of the feasibility process, MI will explore opportunities to identify and collaborate with additional local partners in Marsabit County to enhance coverage, sustainability, and local ownership. Furthermore, the study will assess the potential of using Marsabit as a comparative control site to inform the design, scalability, and learning components of the proposed M-Afya 2.0 project. Where relevant, the feasibility will also consider strategic partnerships with microfinance institutions (MFIs) and other sector actors to evaluate modalities for the digital health wallet, system interoperability, and long-term sustainability.

5.0 Methodology

The feasibility study will adopt a mixed-methods approach, combining desk-based research, stakeholder consultations, and participatory field assessments. This approach will ensure that findings are comprehensive, evidence-based, and contextually grounded, informing the design, integration, and implementation of M-Afya 2.0 within the county and national health systems.

5.1 Overall Approach

The assessment will be guided by the principles of relevance, feasibility, coherence, sustainability, and alignment with Kenya’s RMNCAH Framework, the National Digital Health Strategy (2020-2025), and the Community Health Policy (2020-2030). It will place special emphasis on assessing linkages with the eCHIS and interoperability with existing digital platforms such as KHIS, Taifa Care/SHIF, and County Emergency Operations Centres (EOCs), exploring digital readiness, capacity, and functionality of CHPs, supervisors, and targeted communities and understanding community-level digital literacy, hardware access (e.g., phones and shared devices), and factors influencing user adoption of mother-led digital tools. Through this integrated lens, the study will triangulate insights from existing literature, comparable digital health and financial inclusion models, and field-level realities within the targeted counties to ensure that M-Afya 2.0 is both system-aligned and contextually responsive.

5.2 Specific Methodological Steps

1. Inception Phase

• Review of key project documents, national and county digital health strategies, and M-Afya Phase I documentation.
• Development and validation of detailed data collection tools with MI and AICHM teams.
• Refinement of assessment questions and selection of representative sites in Turkana and Marsabit Counties.
• Submission of an Inception Report detailing the approach, tools, and timelines.

2. Desk Review

A comprehensive review of existing documentation and similar digital health and financial inclusion models will be undertaken, highlighting lessons, gaps, and applicable best practices (Annex 1: Lessons from Similar Models).

• M-Afya Phase I reports and results.
• National and county RMNCAH and digital health policies.
• Comparable models such as PROMPTS (Jacaranda Health), Lucy App, CHV-NEO, MomConnect (South Africa), M-Pesa Health Wallets, and GiveDirectly Conditional Cash Transfers (CCTs).
• Global and WHO literature on digital and financial inclusion interventions in maternal and newborn health.

3. Key Informant Interviews (KIIs)

Semi-structured interviews will be conducted with key stakeholders, including:

• National and County RMNCAH departments (MOH, County Health Departments).
• Digital health and private sector actors (Jacaranda Health, Philips, BBraun, Laerdal, Safaricom, GSMA, rescue.co).
• Development partners and implementing agencies (AICHM, UNICEF, WHO, GIZ, AMREF, USAID).
• CHPs, facility in-charges, and service users in the target counties.

4. Field Data Collection and Participatory Assessment

Field visits will be conducted in selected sub-counties of Turkana and Marsabit, focusing on:

• User readiness and digital literacy among CHPs and community members.
• Access to hardware (phones, tablets) and network connectivity constraints.
• Barriers to adoption, including cultural perceptions and trust in digital systems.
• Opportunities for integration with eCHIS, health facility EMRs, and SHIF/Taifa Care systems.

Participatory focus group discussions and community dialogues will be conducted to ensure inclusivity and representation of diverse community voices.

5. Comparative Analysis and Synthesis

Findings from the desk review, KIIs, and field data will be triangulated to:

• Map enablers and barriers across systems and stakeholders.
• Identify feasible entry points for M-Afya 2.0 integration.
• Outline context-specific recommendations for design, pilot implementation, and potential scale.

6. Validation and Dissemination Workshop

Validation workshops will be convened in Turkana and Marsabit Counties with MI, AICHM, MOH, and key partners to:

• Review preliminary findings.
• Test key assumptions and refine recommendations.
• Co-create the final roadmap for M-Afya 2.0 feasibility and design.

5.3 Data Management and Quality Assurance

All data will be collected using standardized, pretested tools, with daily quality checks during fieldwork. Quantitative and qualitative data will be securely stored, anonymized, and analyzed in accordance with MI’s data protection and ethical standards.

5.4 Ethical Considerations

The consultant will uphold the highest ethical standards throughout the assessment, ensuring:

• Informed consent, confidentiality, and voluntary participation of respondents.
• Cultural sensitivity during field engagement.
• Ethical clearance obtained from relevant national research authorities prior to data collection.
• Integrated references to eCHIS, EMRs, SHIF/Taifa Care, and EOCs for consistency with earlier sections.
• Clear inclusion of digital literacy and hardware access as feasibility dimensions.
• Streamlined language for flow and readability while preserving your original detailed content.
• Consistent formatting (headings, verbs, sequencing) with MI’s TOR style.
• Ends with strong compliance and ethics alignment.

6.0 Structure of the study and guidelines

The feasibility study should present the program context and analysis at micro (community/CHP and facility), meso (county health management), and macro (national policy and systems) levels. It should include essential baseline data relevant to M-AFYA 2.0 and reflect linkages to Malteser International’s broader Health System Strengthening (HSS) and Humanitarian–Development–Peace (HDP) Nexus approach in Kenya.

The final report shall be structured as follows:

1. Purpose and Use of the Feasibility Study

• Examine the feasibility and contextual relevance of the proposed M-AFYA 2.0 project objectives, including technical, operational, and financial aspects.
• Assess the coherency of the cause–effect relationships across sectors (digital health, RMNCAH, financial inclusion), project components, and geographic areas.
• Evaluate the extent of shared learning and potential synergies with existing programs, including PROMPTS, Lucy App, CHV-NEO, Healthy Entrepreneurs, and eCHIS, as well as alignment with national and county digital health strategies.

2. Methodology

• Apply participatory methods throughout the study to capture diverse perspectives, including Key Informant Interviews (KIIs), Focus Group Discussions (FGDs), and stakeholder workshops.
• Collect both quantitative and qualitative data to ensure triangulation across policy, systems, and community realities.
• Conduct interviews and consultations with:
• MI and AICHM project management staff
• County and sub-county RMNCAH and Digital Health officers
• Community Health Professionals (CHPs) and their supervisors
• Health facility managers and frontline workers
• Beneficiaries (pregnant lactating women (PLW), mothers, youth, fathers)
• Development partners and private sector digital innovators (e.g., Jacaranda Health, Safaricom)
• Field data collection shall cover all planned project locations in Turkana and Marsabit counties.

3. Study Results

The report should include:

• Background analysis of the RMNCAH, digital health, and community health context, including an assessment of eCHIS functionality and its linkages with facility-level and national data systems (KHIS).
• Mapping of the current digital ecosystem in target areas and lessons from comparable models and financial inclusion platforms (Annex 1).
• Assessment of framework conditions that could affect implementation of policy, socio-cultural, geographic, gender, security, or environmental factors.
• Review of financial feasibility, including digital affordability and sustainability mechanisms.
• Identification of policy and operational constraints that need to be addressed prior to implementation.
• Evidence-based recommendations for design and next steps to guide pilot testing and scale-up.

4. Partner in the Country

• Determine the appropriateness of AICHM as the local implementing partner, assessing institutional capacity, geographic reach, and alignment with M-AFYA 2.0 objectives.
• Review potential collaboration with county health departments and local innovation hubs.
• Review potential collaboration with private healthcare stakeholders.

5. Target Groups and Other Actors (Micro, Meso, and Macro Levels)

• Assess and document the process used target groups, ensuring inclusivity and alignment with the community health strategy.
• Describe the characteristics of target groups, including gender, age, socio-economic status, and digital literacy levels.
• Evaluate how the project integrates community health structures (CHPs, community units) and their linkage with digital health systems (eCHIS, KHIS).
• Analyze the understanding and priorities of target groups and stakeholders concerning project goals and identify any divergent interests or opportunities for synergy.
• Assess the contributions, roles, and influence of key actors including MI, AICHM, Ministry of Health, county governments, and private digital partners.

6. Evaluation of the Planned Project Based on OECD-DAC Criteria[1]

The planned project shall be evaluated according to the OECD-DAC evaluation criteria, specifically:

• Relevance: Alignment with national priorities, RMNCAH and digital health strategies, and local needs.
• Coherence: Compatibility with other ongoing interventions (e.g., PROMPTS, eCHIS, M-Afya I).
• Effectiveness: Likelihood of achieving desired outcomes in health access and digital inclusion.
• Efficiency: Cost-effectiveness, resource use, and implementation feasibility.
• Impact: Anticipated benefits for women, children, and health system performance.
• Sustainability: Prospects for institutionalization, local ownership, and integration within eCHIS and county health systems.

[1] Detailed information on evaluation criteria at https://www.oecd.org/dac/evaluation/daccriteriaforevaluatingdevelopmentassistance.htm

7. Recommendations

Based on findings and the DAC assessment, the consultant shall provide concrete recommendations for refining the M-AFYA 2.0 concept, including:

• Adjustments to the impact logic and results framework.
• Recommendations on pilot design, stakeholder engagement, and integration with eCHIS.
• A draft monitoring and outcome tracking plan for subsequent implementation.
• Identification of risks, mitigation measures, and opportunities for partnerships and scale-up.

7.0 Timeframe and Expected Deliverables

The work detailed in this term of reference is to be done in 26 working days from latest 24.11.2025 as agreed upon deliverables with Malteser International. Key deliverables include:

1. Preparatory Stage – 2 days

Review and agreement on the technical and financial proposal.

Final TOR and approved technical & financial proposal.

2. Inception Stage – 2 days

Desk review of background documents (M-AFYA I reports, MI strategy, RMNCAH and Digital Health policies, eCHIS framework), mapping of stakeholders and key digital health models (PROMPTS, Lucy App, CHV-NEO, etc.).

Inception Report including detailed methodology, tools, and Gantt chart.

3. Assessment Stage – 15 days

Field data collection in Turkana and Marsabit: key informant interviews, focus group discussions, and community/facility assessments; data disaggregated by country, gender, age, and disability.

Field data summary and raw data sets for analysis.

4. Reporting Stage – 7 days

• Compilation, analysis, and drafting of findings and recommendations based on OECD-DAC criteria and lessons from similar models. Draft Feasibility Study Report.
• Internal MI review and feedback on draft report. MI written feedback and comments.
• Presentation of preliminary findings through a stakeholder validation workshop. Validation Workshop Presentation and summary notes.
• Integration of feedback and submission of final deliverables. Final Feasibility Study Report (including annexes, data collection tools, and comparative model analysis).

8.0 Key Competencies and Required Qualifications

1. Technical Expertise
   1. Advanced degree in Public Health, Digital Health, Development Studies, or related field.
   2. At least five years of proven experience in conducting feasibility studies, or evaluations, in the health and humanitarian sectors, preferably in ASAL contexts.
   3. Strong understanding of Maternal, Newborn, and Child Health (MNCH), digital health innovations, and community health systems strengthening.
   4. Familiarity with Kenya’s Community Health Strategy, Digital Health Policy (2020–2025), and RMNCAH frameworks.
2. Methodological Competence
   1. Demonstrated ability to apply qualitative and quantitative research methods, including participatory and gender-sensitive approaches.
   2. Proven experience in applying the OECD-DAC evaluation criteria and translating findings into actionable recommendations.
   3. Strong analytical, synthesis, and report-writing skills.
3. Institutional and Contextual Competence
   1. Solid understanding of Kenya’s health governance structures at national and county levels, particularly in Turkana and Marsabit.
   2. Experience working with government counterparts, faith-based organizations, and development partners in the health or digital sectors.
   3. Knowledge of financial inclusion or digital payment systems in low-resource settings is an added advantage.
4. Team Composition
   1. Multidisciplinary team with expertise in public health, digital systems, socio-economic analysis, and gender and social inclusion.
   2. At least one team member has experience in data management, GIS, or digital interoperability assessments.
   3. Excellent command of English; proficiency in Swahili or local languages (Turkana, Rendille, Borana) is desirable.
5. Professional Attributes
6. High level of professionalism, independence, and ability to meet deadlines.
7. Adherence to ethical research practices, data protection, and inclusive engagement principles.

Tagged as: Kenya, Malteser International