A survey of mothers and healthcare workers from Jacaranda Health’s PROMPTS and MENTORS platforms

We have all heard about the ripple effects of USAID funding cuts – on large programs, global initiatives, research, and jobs in the global health landscape. But what do these cuts mean for the mothers and healthcare workers we serve in Kenya, and how could/should local health outfits and their funding partners rally to protect them?

We conducted a SMS-based pulse survey on March 8th with two groups: mothers enrolled on our digital health platform PROMPTS, and frontline nurses who have participated in our mentorship training programs. These respondents represented a broad cross-section of the Kenyan population: we operate in 23 of the country’s 47 counties, and our nursing mentors work across 300+ health facilities.

We heard from nearly 6,000 women who indicated they had been to a health facility in the last month, and over 500 frontline healthcare workers, primarily nurses in public health facilities. Additionally we spoke to 22 of our partner counties about their experiences of the cuts. Insights from their responses are below:

1. Mothers are waiting longer for essential check-ups. 42% of surveyed participants reported longer wait times at clinics driven, in part, by staff shortages. Some responses:

• “We arrive by 8 but we start receiving the services even around 10.”
• “Most of the medicine is not available, you’re sent to buy.”
• “There is a shortage of vitamin A” / ”The child didn’t get vitamin A at 6 months.”/ “There were no vitamins for the baby.”

2. HIV positive mothers face a range of issues accessing services. Among mothers who had previously disclosed that they were on HIV medication, we asked anonymized follow-up questions about recent service access. 935 of these women said they had been to a clinic in the past month, and among these women: 

• 18.6% reported that they were unable to get their medication refilled (Note: For HIV-positive mothers, our SMS questions did not explicitly refer to “ARVs” or “viral load tests” to preserve confidentiality. Therefore, responses may reflect a range of interpretations.)
• 19.6% did not receive the tests they went to the facility for. “No equipment to test the baby”.
• 30.5% reported a change in the services received, including:
  • “They didn’t have ferrolic* tablets.” (*iron supplement used to treat or prevent low blood levels of iron, especially administered during pregnancy)
  • “I didn’t get any service.”
  • “There were no doctors on duty.”
  • “The antenatal nurses were not there.

3. Frontline health workers are being laid off. 61% of approximately 644 respondents reported that staff at their facilities had been sent home due to the USAID stop work order. Among these who estimated the number of staff being sent home: 

• 70% said that between 1–10 staff members were affected.
• Over 19.9% reported that more than 10 staff had been sent home.
• The most commonly cited roles impacted were HIV-specific, as well as PMTCT specialists working to prevent mother-to-child transmission of HIV, hepatitis B and C, and syphilis. 
• Others mentioned absences in “general” staff—highlighting the broader impact on primary care providers.

Respondents flagged the impact of these absences on the workloads and motivations of remaining staff, with some services being integrated into others, causing burnout. 

• “There are too few staff, we can’t handle it.”
• “Workload has become too heavy.”

Others cited stress, and demotivation connected to fears around impending job loss: 

• “Many people have lost their jobs, and others fear losing theirs.”
• “Healthcare workers are discouraged and lack motivation.”

4. Health workers have noticed a decrease in essential supplies. Reinforcing mothers’ reports of missed services and medicines, 61% of healthcare workers said they had seen a decrease in essential supplies, including medication, test kits, and other commodities. Cited shortages included antiretroviral drugs, or ARVs, to treat HIV infection, contraceptives, immunizations, iron folate, and antimalarials. For example:

• “ARVs are out of stock”
• “There are no HIV medicines and contraceptive pills.”, “No HIV testing kits.”
• “There are no malaria medicines.”
• “There is a shortage of cervical cancer screening tools.”
• “There is no service for viral load testing.”

5. Counties are struggling with the immediate impact of the USAID cuts and program closures on county healthcare staff, supplies and systems. 

• All 22 counties reported having to send staff home or lay staff off from key services, including programming for MNH, HIV, nutrition, cervical cancer, GBV, and family planning. From our brief analysis, staff layoffs already total 1,000+. Many counties reported that all PMTCT staff previously under USAID support have been sent home, while other counties reported letting go staff from family planning programs.
• All counties reported commodity stock-outs especially on HIV products, tuberculosis and PMTCT drugs, nutrition supplements, lab test kits, and contraceptives. Counties reported halts in ‘All supplies of ARVs’, and ‘Sanitary pads, MUAK test kits and food supplements.’
• 14 out of 22 counties reported that none of the services that had been temporarily frozen with the funding cuts had resumed. 
• Some counties reported impact on their IT and data infrastructure. One county shared that ‘Facility EMR (Electronic Medical Record) has been completely affected’.

Discussion and next steps

It is hard to project how this transition will play out in Kenya’s public health system over time. What we can quickly surmise from this pulse survey is that the cuts are already having a marked impact on the quality, timeliness and completeness of MNH services. 456,000 women annually rely on USAID-funded MNH services (Kenya Healthcare Federation, 2025), many of them for life-saving things like ARVs and malaria medications. 

County governments are looking for rapid, yet sustainable solutions to plug the funding gaps in resource-constrained health budgets. Local health organizations play a unique role because they can respond quickly in the dynamic market created by the drop in foreign aid. Jacaranda is continuing to provide support to its county partners, leveraging its health system insights and broad/diverse network of mums and providers. 

Here are some ways we’re thinking about this support:

• Continuous digital support for mothers and babies: Facility-based services have been affected. Digital tools can play a role in providing remote counseling support to mothers, and streamlining uptake of limited services. Along with SMS health information, PROMPTS can provide triaging support to alleviate the burden of either mothers making unnecessary (and costly) trips to hospital, or already-stretched facilities catering for high volumes of non-urgent cases. Additionally (as this survey has shown us), PROMPTS collects data on mothers’ experiences at scale, which can help counties identify evolving gaps as they happen (eg. ARV stock-outs, staffing shortages in certain facilities etc.)
• Real-time health system insights to target limited resources. As the situation evolves, county health management teams will increasingly need to rely on data to understand the worst-affected areas, their underlying drivers (eg. shortages of specific medicines), and where/how to funnel increasingly-limited resources. However, KHIS2, Kenya’s national data system, is currently down (USAID cuts have impacted the payment of the DHIS2 service fee). Jacaranda’s field teams say that our county and facility partners are increasingly relying on our dashboards, PULSE, which triangulate outcomes data, alongside real-time data from mothers (eg. service uptake, experience), providers (eg. skills, knowledge), and facilities (eg. availability of commodities, staff, equipment). We see potential to ramp up PULSE utilization further to help counties navigate these changes – by collecting additional data to monitor emerging gaps (eg. ARV uptake among HIV positive mothers), and county capacity building around data literacy, reporting and utilization. 

Sustainable approaches to improving and tracking provider performance. We will continue to provide essential EmONC training to frontline staff via our mentorship program, to maintain quality and continued coordination/ communication amid service disruptions and staff absences. Through this program, and our digital learning assistant DELTA, we will track trends in provider performance during these disruptions, as well as monitoring additional indicators (eg. job satisfaction, absenteeism, staff distribution) to understand the impact of funding cuts on healthcare workers and support county partners in addressing workforce challenges.