Turkana County, in north-west Kenya, is vast. Its open landscapes stretch as far as the eye can see—painting a picture of both beauty and challenge.
The arid land makes Turkana extremely susceptible to severe drought. People struggle to obtain food, and cattle rustling is a common occurrence. The county has one of the highest Global Acute Malnutrition rates, at 21.8%.
The R-SWITCH initiative, launched in February 2025, has set about addressing that.
What is R-SWITCH?
R-SWITCH is an implementation research collaboration between Turkana County Government, UNICEF Kenya, International Food Policy Research Institute (IFPRI), Kenyatta University, the International Rescue Committee (IRC), and Medic. It aims to improve the evidence-based screening, identification, and treatment of severely malnourished children under five through digital technology.
The initiative will develop a two-way digital messaging platform between community health workers and caregivers, providing families with app-based prompts, awareness, and training to screen their children for acute malnutrition by taking mid-upper arm circumference (MUAC) measurements. By strengthening the community’s understanding of malnutrition, the program aims to ensure that children impacted by it are identified, referred and treated earlier—ultimately saving lives.
This support will be provided through enhancements made to Kenya’s national electronic Community Health Information System (eCHIS), which currently guides over 107,000 community health workers—known as Community Health Promoters (CHPs) in Kenya—to deliver household care.
Turkana County: What’s happening on the ground?
Through R-SWITCH, I had the opportunity to join an exploratory visit to Turkana County for the first time in April 2025.
As someone deeply involved in digital health work, I’ve read the reports, reviewed the data, and attended numerous planning meetings. But nothing compares to stepping into the field and experiencing the reality behind the strategy.
The region’s remoteness underscores exactly why community-based health research, like R-SWITCH, is so critical; just getting to Turkana by road means a two-day drive from Nairobi.
Access isn’t just about having a facility nearby—it’s about overcoming terrain, infrastructure gaps, and deep-rooted inequities.
Our visit aimed to engage directly with the stakeholders who will be at the center of R-SWITCH’s implementation, from Community Health Assistants (CHAs) and CHPs to county health officials and NGO partners. It was a chance to understand the real-world context, gather evidence to validate assumptions, and listen to the people who understand the health landscape best.
At its core, R-SWITCH is about improving screening, referral, and treatment for children with acute malnutrition. During our conversations, it became evident that CHPs are the first—and sometimes the only—point of contact for families in these communities. Their insights were invaluable in shaping our approach to workflow design, messaging, and digital follow-up processes.
The Challenges: Beyond Technology
One of the biggest takeaways was that while technology can be an enabler, it is not a silver bullet. We saw firsthand how limited network connectivity, high malnutrition caseloads, and geographic barriers affect daily service delivery. It reminded us that any digital solution must be simple, offline-friendly, and rooted in the daily realities of CHPs and caregivers alike.
The Community Health Toolkit (CHT) was chosen because it is designed for low-resource settings, works reliably offline, and integrates seamlessly with national systems like eCHIS Kenya—making it a practical and sustainable choice for Turkana’s context.
Human-centered design: People at the heart of the work
What made the visit especially meaningful were the interactions. As a CHA explained how she tracks people who’ve missed appointments, and a CHP walked us through his challenges with data entry and household visits, it brought home to me that these were not just stakeholders—they were co-creators of the future we’re building through R-SWITCH.
My first time in Turkana was eye-opening—not just because of the work, but because of the people. At a household visit, faced with the reality of the family’s struggle to get food, I found myself shedding a tear and had to excuse myself.
Their resilience, clarity, and commitment to improving health outcomes inspired me deeply. It gave me a whole new perspective on the work that we do. We’re not just building apps; we’re building apps that impact people’s lives. We’re not just helping a rural community; we are bridging the gaps for swifter access to treatment.
What’s Next: Iteration, feedback, and user assessments
This exploratory visit helped lay the groundwork that will inform the program’s design and engagement. It reinforced the importance of human-centered design, inclusive planning, and local ownership.
The path ahead will involve feedback loops, iteration, and shared learning, but the foundation is solid.
As we move forward with R-SWITCH, I carry with me a simple reminder: we design better when we listen first.
Acknowledgement
This work is made possible through funding from the Gates Foundation