Authors: Irene Nyaoke, Rael Mutai, Lucy Nyaga
Globally, every day , 810 women die from preventable causes related pregnancy and childbirth (WHO 2019). In Kenya, for every 100,000 live births, 362 mothers die from complications of pregnancy and childbirth i.e., Maternal Mortality Ration/MMR (KDHS 2014). Majority of these deaths are not only preventable but occur in health facilities. According to Kenya national annual maternal and perinatal death surveillance and response (MPDSR) report 2021, the facility MMR in Kenya (2021) is estimated at 110/100,000 live births and Garissa recorded the highest at 234 maternal deaths per 100,000 live births. Quality of health services across the Reproductive, Maternal, New-born, Child and Adolescent Health (RMNCAH) continuum of care can reduce adverse outcomes of pregnancy. Knowledgeable, respectful, motivated, and competent health care providers (HCPs) make a significant contribution to the quality of care provided in health facilities.
The Liverpool School of Tropical Medicine (LSTM) in collaboration with Kenya Ministry of Health(MOH) is implementing a Quality Improvement Program for Integrated HIV, TB, and Malaria services in Antenatal and Postnatal Care. The project, funded by the Global Fund (Takeda Global CSR) has not only provided capacity building for in-service HCPs but also addressed other ‘bottlenecks’ to quality services including unavailability of basic MNH equipment.
Good-quality care requires appropriate use of effective clinical and non-clinical interventions, strengthened health infrastructure, optimum skills, and a positive attitude of health providers. These will improve health outcomes and give women, their families, and the health care providers a positive experience.
To address immediate gaps in terms of essential equipment and supplies at healthcare facility level that are essential for the delivery of the components of ANC and PNC, in line with national and international standards, a (small) Facility Improvement Fund (FIF) was allocated within the project, to support specific identified and limited infrastructure and equipment needs. This FIF was provided after consultation of country stakeholders on the needs and priorities based on findings of the conducted health facility baseline assessment.
“We gained a lot of knowledge from the training by LSTM, but if we do not have the equipment to practice the skills we learned, it is very difficult to complete the task”, Healthcare provider, Garissa County
Using the facility improvement fund (FIF), the missing equipment was procured by LSTM Kenya Office and distributed to the respective counties and health facilities. Some of these include examination couches, curtains/screens, stethoscopes, tape measures, doppler fetal monitors, pinard stethoscopes, clinical thermometers, manual blood pressure machines, patella hammers, baby weighing scales (newborn) and wall clocks.
During the handover ceremonies held at the three Counties of Garissa, Uasin Gishu and Vihiga, LSTM reiterated that efforts to improve quality of ANC and PNC, in the absence of the required basic equipment to provide the service, may not translate to significant impact. These calls for holistic approach to health systems strengthening that addresses all the building blocks concurrently for optimum outputs.
“I am so happy today because LSTM has been able to think about us and brought this equipment which will help to reduce maternal and neonatal morbidities and mortalities. Through this and other support from LSTM, we have been able to narrow down our capacity gaps in terms of staff knowledge and skills, quality of care and equipment supplies; we thank you LSTM” Veronica Musiega, County RH Coordinator, Vihiga
While the programme will not address larger and longer-term needs for human resources, infrastructure, equipment, and consumables, key gaps and “bottlenecks” identified will be fed back as part of the routine monitoring and evaluation process, so they can be addressed by the relevant mechanisms in the healthcare system. This linked with the quality improvement component of the programme will help to provide impetus for enabling change in the health system to ensure reduction in ‘stock outs’ (of essential drugs, vaccinations, diagnostic supplies etc.) which need to be addressed to promote availability and quality of integrated ANC and PNC as part of the facility and health system management.
By partnering with Ministry of health, LSTM remains committed to improving the availability and quality of integrated HIV, TB and Malaria services provided at healthcare facilities, and contribute to better maternal and new-born health outcomes.