Auditor General Gathungu blames high maternal and neonatal deaths on poor funding

Health facilities in 11 counties were sampled, all found to have inadequate equipment

In Summary
  • In some of the facilities, mothers were discharged two to six hours after delivery to minimise congestion, exposing them to postpartum haemorrhage
  • Delivery kits were also in short supply, compromising infections control
Expectant mothers at Kirwara hospital in Gatanga during the launch of a programme that issues stipends to expectant mothers in March last year.
Expectant mothers at Kirwara hospital in Gatanga during the launch of a programme that issues stipends to expectant mothers in March last year.
Image: Alice Waithera

The auditor general has blamed poor funding of health facilities for the high prevalence of maternal and neonatal deaths in the country.

The report by Nancy Gathungu found that 4,307 new born babies died in 2021 while 495 mothers died during delivery.

The audit report, released in October, attributed the neonatal deaths to sepsis, asphyxia and premature births.

Most maternal mortalities were blamed on post-partum haemorrhage sepsis and preeclampsia (a condition characterised with high blood pressure occurring during pregnancy). 

It revealed that the government only funded 10 per cent of maternal health activities while 90 per cent were funded by donors and implementing partners.

But Gathungu expressed concerns that some counties are left out as donors focus their activities on select areas, based on their indicators.

“Having a majority of activities being funded by donors and implementing partners presents a challenge of lack of uniform capacity building and technical assistance to all the 47 counties,” she said.

The audit sampled health facilities in 11 counties and found that all had inadequate equipment for delivery of maternal and neonatal health services.

There were insufficient delivery coaches and the available ones were not adjustable, making it difficult for nurses to position mothers during delivery.

It cited Pumwani maternity hospital whose delivery beds were all unadjustable, while Kacheliba sub-county hospital in West Pokot had three - out of which two had broken down at the time of the audit.

Nziu health centre in Makueni had only one delivery bed, while Siaya county referral hospital had four, but only one was ideal.

The situation was even worse at Jaramogi Oginga Odinga Teaching and Referral hospital in Kisumu where four delivery beds were not ideal.

Delivery kits were also in short supply.

“Facilities with inadequate delivery kits had to constantly sterilise the few available after use which was time consuming especially for facilities with staff shortage,” the report revealed.

With an average daily delivery of between 10 and 15 mothers, Isiolo County Referral hospital had only nine delivery kits, compromising infections control.

Kabichbich health centre in West Pokot was found to have old and rusted delivery kits that were not hygienic for use, while Miti Mingi dispensary in Nakuru had five incomplete delivery kits.

Most level two and three health facilities did not offer ultrasound services - despite providing antenatal services -  and had to refer expectant mothers to other hospitals.

While in most cases only mothers who had normal deliveries shared beds, those who had undergone caesarean section in Bungoma County Referral and those at Mbagathi Hospital in Nairobi were forced to do so.

In some of the facilities, the Auditor General noted, mothers were discharged two to six hours after delivery to minimise congestion, exposing them to postpartum haemorrhage.

Murang'a Level Five hospital.
Murang'a Level Five hospital.
Image: Alice Waithera

Inefficient provision of health care services by the government hindered the reduction of maternal and neonatal mortalities.

A low number of community health workers also resulted in a reduced number of expectant women seeking antenatal care, due to lack of awareness.

The report identified a positive correlation between the failure by expectant women to attend at least four antenatal clinics with maternal and neonatal mortalities.

It sampled 19 units that were found to be inadequately equipped to offer newborn care.

“In all the sampled newborn units, it was observed that two to three babies shared an incubator. This posed the risk of spreading infections among the neonates.”

Kangaroo Mother Care, that is recommended for preterm infants, was inadequately supported in most facilities.

The approach boosts preterm infants' growth and enhances the bond with the mother. 

Some hospitals did not have beds, forcing stable but premature infants to be admitted in newborn units, which was found to slow their growth and delay their discharge.

A review of 146 death review forms recorded during or before delivery revealed that a large number were attributed to delays in accessing ambulances either at the community level or from one facility to another.

In some of the counties, the inefficient referral system was attributed to insufficient or ill equipped ambulances, lack of a command centre and challenges fueling the vehicles.  Some facilities used private vehicles that did not have emergency care equipment.

“Interviews with County Health Management Teams indicated that only Nairobi, Kisumu, Makueni and Garissa had a centralised command unit that enabled them to dispatch the available ambulances efficiently,” the report read.

The national government is in the process of transitioning from NHIF to the Social Health Insurance Fund that will register all Kenyans and non-Kenyans residing in the country.

SHIF has however been criticised for scrapping the Linda Mama programme that provided free maternal services in public hospitals.

Instead, the new system introduces a package that will cap its contributions to Sh32,000 for caesarean sections and Sh11,200 for normal deliveries.

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