<p>The monthly workload of six health facilities in Nyeri was compared with that of similar facilities in the non-participating county of Embu. Workload was downloaded from the Kenya health information system for aggregate reporting. Monthly data on workload for each hospital was extracted from the Services Workload reporting tool .Monthly means for each indicator over the two periods was calculated and the proportion of change calculated. The difference-in-differences method was used to calculate monthly change among each indicator in the intervention health facility. The facilities analyzed were two level 5 hospitals, 6 level 4 hospitals and 6 level 3 health facilities</p>