Mother and baby health an imperative

There is an African proverb that goes, “It takes a village to raise a child.” I believe it also takes a village to bring a child into the world. Being a mother, a doctor and the Migori county Health executive, I am deeply grateful for the people who make safe motherhood a reality. These include community health volunteers, midwives, healthcare providers, families and the broader community.

Safe motherhood cannot be achieved in isolation. In Migori, we have taken a 360 degree approach to ensuring mothers have safe pregnancies and deliveries, including by working hand-in-hand with communities to encourage mothers to give birth in hospitals, which is a safer option.

There are several programmes aimed at ensuring women in labour arrive in health facilities. For instance, we have partnered with boda boda operators to transport women to hospital as quickly as possible. For each mother that an operator in the programme brings to a hospital, he or she receives Sh400.

In Nyangoge, Kuria West subcounty, a community-based referral system ensures that mothers in labour are transported to health facilities via motorcycles or cars. This has resulted in 100 per cent hospital delivery rate.

We have incentivised giving birth in health facilities by offering mama packs to mothers. The packs contain basic supplies for newborns, including a blanket, baby tub, socks and Vaseline. Currently, seven out of 10 births are attended by a skilled health worker. Our goal is to reach 90 per cent so that every mother has a shot at a healthy delivery.

Through the Preterm Birth Initiative, Migori is the first county to pilot a high-impact quality improvement intervention – the WHO Safe Childbirth Checklist. The WHO Safe Childbirth Checklist is a simple tool that reminds health workers of the critical steps they need to take to prevent maternal and newborn deaths.

This includes washing hands to prevent sepsis, monitoring a mother’s bleeding and blood pressure, and making sure newborns breastfeed and are kept warm, among others. Nurses have come to trust and rely on the Checklist as a quality improvement guide that makes their work easier while helping them to quickly identify danger signs and address them accordingly.

Yet, even health workers cannot work in a vacuum. They need infrastructure and policies that create favourable working environments. Migori has invested in building modern maternity units in all subcounty hospitals and a fully-equipped newborn unit at the county referral hospital. In addition, we are working hard to put the right policies in place.

To track performance on key maternal and newborn health indicators, we have developed a scorecard system that evaluates all facilities. Members of the County Assembly help track results in different facilities using geo-maps that provide real-time data on which facilities need further support to improve maternal and child health outcomes.

Furthermore, we have adopted a knowledge-to-action cycle which highlights important gaps in the system, allowing us to make much-needed change. For example, data shows that about 70 per cent of maternal deaths occur outside working hours (after 5pm to before 8am, weekends and public holidays) when staff are less likely to be available.

As a result, Migori now mandates that all health facilities have 24-hour coverage, allowing more mothers to get access to the healthcare they deserve, regardless of the time of day.

These efforts are commendable, but we cannot stop there.

The survival of mothers and newborns is an important indicator of the overall wellbeing of a country. As Kenya rolls out universal health coverage, improving maternal and newborn health must remain at the centre of this vision.

Health CEC, Migori county