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Childbirth deaths in Kenya need deep reflection and interventions

In Summary

• I am sure other Kenyans have worse experiences, and the emotional and the spur of the moment outbursts, which we go back to the usual normal.

• A 2019 report commissioned by the Open Society Initiative for Eastern African on to assessing the impact of “free maternity services initiatives” in Kenya established the reasons for the increasing number of maternal deaths. 

Woman and baby died in Mt. Elgon sub county hospital due to negligence.PHOTO/COURTESY
Woman and baby died in Mt. Elgon sub county hospital due to negligence.PHOTO/COURTESY

The mother captured giving birth outside Pumwani Maternity Hospital’s main entrance recently temporarily attracted some attention from Kenyans, who feigned some irritation and made noise.

This is what been is happening to our mothers every day in Kenya across the counties, and because they have no access to media, they suffer and die silently.

The health sector in the country requires attention and focus because, without healthy people, a lot of our aspirations will not be achieved. 

It's not just resources, but the attitude of staff, motivation and accountability in the sector, for this is killing many Kenyans.

Streamlining the different roles between the national and county in the sector have to be dealt with and increasing the number of functional health facilities to Kenyans is critical, otherwise, the nice government pronouncements on abolishing user fees on maternal health services are just mere talk.

Twice, I have had to pay for an ambulance and related costs to have my relatives transferred from Sio Port Sub County Hospital to Busia County Referral hospital for delivery purpose, after a delay of nearly five hours.

One was lucky and even with the delay after haggling over payment, she survived and the child. The other one, delayed and by the time of reaching the county hospital, going through an operation, the child died, while on the oxygen machine.

I am sure other Kenyans have worse experiences, and the emotional and the spur of the moment outbursts, which we go back to the usual normal.

A 2019 report commissioned by the Open Society Initiative for Eastern African on to assessing the impact of “free maternity services initiatives” in Kenya established the reasons for the increasing number of maternal deaths.

Remember in 2013, the Government introduced free maternal health care services in public health facilities aimed at enhancing access to quality maternal health care services and consequently reduce maternal deaths as provided for in the constitution. 

This was immediately followed by the first lady initiated “Beyond Zero Campaign” in 2014 to accelerate the access to maternal health. The impact of these initiatives, and within the bigger government commitment on access to universal health, will be interesting to assess.

The OSIEA study focused on selected health facilities in three counties namely Nairobi, Migori and Kilifi.  

Among the findings by the study was that the amount of money being reimbursed to health facilities for maternal health services by the government was inadequate to provide quality maternal health services.

This led to mothers being asked to buy supplies like gloves, cotton wool and spirit for delivery to be used for delivery.

It was established that the free maternity pronouncement while showing the much needed political goodwill and commitment from the highest office in the land, has not been matched with the prerequisite infrastructure to actualize the statement.

Public health facilities in the country are not equipped to provide services because of lack of resources.  The declaration mainly focused on the reduction of financial barriers without considering other important impediments like culture, distance to the health facilities, the authority to make decisions on the utilization of health services, staff attitude, and motivation, as well as the availability of adequate equipment and supplies, as key factors in accessing maternal health services.

The study findings further indicate a lack of accountability for maternal deaths. According to findings, health care, and more so pregnancy, has been seen as a personal challenge not affecting anyone else.

The individual, family and immediate relatives suffer in silence without telling anyone what they are going through. Most people end up blaming themselves for not having done enough to save one of their own.

There is a serious lack of accountability in terms of the use of resources.  In many instances, the Government reimbursements were not forthcoming as expected, facilities provided poor quality services and lack of basic supplies forced providers to refer clients to private health facilities where they were expected to pay for the services rendered.

The study reveals an increase in maternal deaths following the implementation of “free maternity initiative”.

The National Hospital Insurance Fund (NHIF) program on supporting maternal health services was lauded as a preferred method of financing maternal health care, where the government enrolls all pregnant women by paying Sh.500 and then the mother receives all the services funded by NHIF.

A number of recommendations were made including need to enhance information availability, accessibility and sensitization of the population on the available health products and opportunities that can improve access to health care including regarding NHIF services.  

Additionally, community-level accountability mechanisms should be enhanced, and all maternal deaths reported and documented and where possible, corrective measures taken to avoid repeat occurrences.

In Kenya, it is estimated that 6,300 women die each year during pregnancy and childbirth.

According to the World Health Organization (WHO), Kenya is among the 10 countries that comprised 58 percent of the global maternal deaths in 2013, contributing two percent of these deaths (WHO, UNICEF, UNFPA and the World Bank, 2015).

Despite the notable progress made in several maternal health indicators such as the reduction in maternal mortality ratio from 414 in 2003, 488 in 2008-2009 to 362 in the 2014 Kenya Demographic and Health Survey, a lot still needs to be done to save women from dying during pregnancy and childbirth (Central Bureau of Statistics (CBS) Ministry of Health (MOH) & ORC Macro, 2004; KNBS, 2010, KNBS 2014).

Globally, there is a renewed momentum and support for reproductive health as part of the Sustainable Development Goals (SDGs) and the updated Global Strategy for Women’s, Children’s and Adolescent Health (2016-2030).

It aims to achieve the highest attainable standard of health for all women, children and adolescents, and ensure that every newborn, mother and child not only survives but thrives.