In Kenya, the chamas strategy (a peer support approach aimed at improving MNCH and reducing gender and social inequalities) has been shown to significantly improve maternal and child health outcomes while also providing social and financial support to participating women. However, the COVID-19 pandemic caused significant disruptions in women's work and MNCH services around the world due to reallocation of health care resources, COVID-19 fears, transportation restrictions, and lockdowns. These consequences appeared to disproportionately affect the poor, particularly poor women. The purpose of this participatory action design study is to determine how Chamas participation intersected with other factors to mitigate the effects of the COVID-19 pandemic on the health and economic well-being of women and children.

The study objectives are:

To evaluate the effect of Chama participation on mitigating the effects of the pandemic on social and gender equity.

• Impact on economic status (assessed using the changes in the Poverty Probability index scores)
• Impact on health service utilization and behaviours (assessed using enrollment in the national health insurance scheme, number of ANC visits attended, facility delivery, maternal death, newborn death, infant death, exclusive breastfeeding, number of children fully immunized at age 1)
• Social attitudes and well-being (assessed using, attitude towards harsh punishment of children, level of parental stress)
• COVID-19 related information (assessed using COVID-19 infection, COVID-19 vaccination, and effects of COVID restrictions)

To use an equity-centered design process and narrative approach to share research findings.

The research team intends to evaluate women's experiences during the pandemic using a mixed method approach and a participatory action design method. The focus will be on 3 study cohorts: (1) women who participated in Chamas throughout the pandemic, (2) women who left Chamas during the pandemic, (3) women whose communities were randomized to not receive the Chamas intervention. To better understand the effects of Chama participation on study outcomes, we will conduct an interviewer-administered survey among the described cohorts of women. This will be followed by qualitative studies to contextualize the study findings and investigate gender dynamics as social processes. Focus group discussions (FGDs) and key informant interviews (KIIs) will be conducted to further investigate our study cohort's experiences during the pandemic and identify strategies used by participants to mitigate the negative effects of the pandemic and its associated restrictions.

Inclusion Criteria:

• Women who participated in the 2021 Chamas study in Western Kenya

Exclusion Criteria:

• Women who did not participate in the 2021 study.

This research will be conducted in Trans-Nzoia County among the 1400 women that participated in the 2021 RCT study. The following groups will be included in our study population.

• RCT women who participated in Chamas throughout the pandemic.
• Women who left Chamas after March 12, 2020, the date the first case of COVID-19 was discovered in Kenya.
• Women whose communities were randomly assigned not to use Chamas during the RCT.
• CHVs in communities that had or did not have Chamas operating during the pandemic.
• County health officials.
• Fathers participating in Chama cha Babatoto.
• Adolescent girls are currently participating in Chamas adapted for adolescents.