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Courtesy/Images of Empowerment
In our work we support coalitions and government to identify issues that put women and girls at risk of losing lives during pregnancy and childbirth. E4A-MamaYe supports civil society, media and governments to champion Primary Health Care (PHC), family planning and quality MNH services. Our approaches promote collaboration and use of evidence to make decisions on how available resources can be effectively used. A month after Kenya’s election, we held meetings with government in Bungoma county taking stock of progress and setting priorities for coming days.
Bungoma Progress in Maternal & Newborn Health
Bungoma is a populous county, located in Western Kenya and neighbors Uganda, North of Lake Victoria. Our partnership with the county government started in the year 2017. Throughout this period, we have seen remarkable progress on key maternal and newborn health indicators. Over the last 5 years for instance, skilled birth attendance increased from 56% in 2017 to 79% in 2021 (KHIS Data). When we started, only 6 out of every 10 women would deliver in a health facility, now it is 8 out of every 10 highlighting a remarkable milestone.
Getting women and girls to deliver at a health facility is one way to reduce and end mortalities. Another way is to get women access and utilize Antenatal care (ANC) services during the period of pregnancy. These indicators grew from 45% and 32% to 53% and 51% for the first and fourth ANC respectively.
Advocacy with the county has yielded results. Evidence from Maternal & Perinatal Death Surveillance & Response (MPDSR) on why mothers are dying in Bungoma, identified excessive bleeding during pregnancy and childbirth as a leading cause. Advocates picked this as an issue of priority during county budget process and a significant milestone was achieved. In 2021, the county government conducted a groundbreaking ceremony for its own blood transfusion center. Construction of this blood center is ongoing and once complete; it will make blood services timely and ensure many women survive pregnancy and childbirth.
“Currently, we have to take blood to Uasin Gishu County in Eldoret town for screening. This is many kilometers away and takes many hours before we get a response. By having our own, we shall improve efficiency of our blood services”
outlines Dr. Johnstone Akatu, County Director of Health.
MPDSR system in Bungoma has been strengthened through partnership between E4A-MamaYe and the county government. A result of this partnership is development of the Action Tracker tool. This Action Tracker, is a game changer on the practice of MPDSR, enabling recommendations to be picked up and included in Annual Work Planning process for resource allocation. These lessons from Bungoma have been replicated in Nairobi City County and 5 other counties in Kenya. A key highlight was World Health Organization (WHO) picking up the Action Tracker tool and including it in the list of essential materials for MPDSR to be used globally.
Strengthening Primary Health Care (PHC) is an important area of focus. Bungoma is a frontrunner and leader in adopting the Vital Signs Profile (VSP) tool used in measurement of PHC performance. In the past year, they had set-up a VSP taskforce and positioning PHC as a top priority in health. Strong PHC will make quality services available to the people- especially women, girls and their babies.
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Courtesy/Images of Empowerment -
Courtesy/Images of Empowerment -
Courtesy/Images of Empowerment
What needs to be done?
Despite progress, still Bungoma has notable gaps to address. Advocates like the Bungoma RMNCAH Network should enhance participation in the process of developing the County Integrated Development Plan (CIDP). The CIDP is a 5-year plan that will guide investment for the county on key priority issues.
This process is driven by huge political interest and presents window of opportunity for advocates to package and present priority issues for consideration. Completion of the blood center should be a priority within the 5-year term of this new administration in Bungoma.
“The challenges we are facing right now is drugs. I have been here for the last 4 months, and we have not been having supplies. We have to ask clients to buy drugs from outside. The facility doesn’t have funds.”
Juma, Clinical officer at Mayanja PHC facility in Bungoma speaks on some of the challenges health workers face and should be addressed to improve quality of service delivery.
The government should put measures to ensure availability and access to essential lifesaving Family Planning (FP) and Maternal Newborn and Child Health (MNCH) commodities. Their plan should improve stock at PHC level facilities. Recognizing the importance of strong PHC for health for all by 2030, Bungoma RMNCAH Network will offer accountability on VSP tool by working closely with the county department of health.
The Bungoma RMNCAH Network will integrate gender transformative advocacy on their work. This coalition has three priority issues on reducing teen pregnancies, increasing uptake of first and fourth Antenatal Care (ANC) and strengthening the referral system. By applying a gender lens, the advocates will ask government to align policy and address gender related root causes to teen pregnancies, low uptake ANC and in the referral system.
E4A-MamaYe has picked lessons on community MPDSR (cMPDSR) from the work we do in Nigeria. Bungoma will pilot this approach in Kenya, reinforcing the weak link on engaging community members to audit deaths of women and newborns that occur outside of the health facilities. Our cMPDSR approach would use the social autopsy tool that would open conversation to address the socio-cultural issues associated with these deaths.
Our team, will continue to provide support to the local advocates and government as they engage to improve health outcomes until all women have safe births.