Simple strategy working wonders

Until the 1990s, having a baby at home  under the care of traditional birth attendants (TBAs) was quite common in Kisii County.

This was mainly because both government-run and private medical facilities were few and far between, so the TBAs, who had some training in child delivery, played a crucial role, especially in remote areas. 

However things have changed. An aggressive campaign by the national government  in the last 20 years to ensure that pregnant women attend clinic and deliver in state-run facilities has slowly but surely discouraged many women from having their babies at home.

Today, many pregnant women can be seen at the county clinics, dispensaries and hospitals seeking antenatal and postnatal care. Deliveries at home are almost unheard of, what with all the health facilities dotting the  county.

Ms Leah Ogega, the Kisii County reproductive health coordinator, who is leading the fight to reduce infant mortality occasioned by poor prenatal and postnatal care in the area, says most women have taken to going for antenatal and postnatal care at state-run health facilities.

“The compliance rate for pregnant mothers in the county is 97.7 per cent,” she says. “This has been aided greatly by the provision of free maternity services, a programme fully subsidised by the national government,” she told DN2.  

“With the advent of  free maternity services in 2013, the infant mortality rate has declined from 52 babies per  1,000 in 2008/2009 to 39 per  1,000 in the county in 2014,” she revealed.

“It is this trend that is responsible for the decline,” she explains in her spacious office.

In another part of the open-plan office, departmental staff are busy working at computer terminals, engrossed in the day-to-day activities, which include  verifying  and analysing data collected from the various health facilities across the county.

“We work very hard to ensure that women go to a health centre for antenatal care,” she says, then pauses for a moment to key in some details on a document she is preparing on her laptop.

“Under normal circumstances, a woman is supposed to report to the nearest health facility as soon as she discovers she is expectant,” she continues.

Ms Ogega goes on to explain that a woman is supposed to visit a health facility at least four times in the case of a normal pregnancy.

“It is only when a doctor detects complications in the pregnancy that she might be advised to make more than four visits,” she says.

She adds that, although every woman determines when to to make the first visit, it should not go beyond 16 weeks after confirming that she’s pregnant.

APPROPRIATE MEDICAL ATTENTION

“When they come, we ensure that they are given appropriate medical attention to facilitate the smooth delivery of a healthy baby when the pregnancy reaches full term.”

The reproductive health boss says that her department liaises with its network of community health workers to find out any cases of home delivery and incorporate those babies in the national and county healthcare system.

“We also cooperate with the administrative personnel at the grassroots level to obtain information on such deliveries for prompt remedial action,” Ms Ogega adds.

She notes the women who have repeat deliveries at home tend to be those who successfully had their first child at home.

“They consider themselves experts in child delivery and, therefore, see no need of going to a health facility the next time they get pregnant,” she offers.

Ms Ogega says that antenatal care comprises several  vital components.

First, the mother is screened to determine whether she has a condition like diabetes and hypertension.

“The process involves lab tests to determine whether she has any sexually transmitted infections like gonorrhoea, syphilis, herpes or HIV. We also screen her for any other condition that might endanger her life during the  gestation period,” she says.

The medical personnel also take the patient’s history by interviewing her in order to capture any details that might have been missed in the medical examination, Ms Ogega adds.

This medical history is essential in providing medical personnel with accurate details on a woman’s health.

“It is often the only tool we have for detecting and handling problems that might complicate the chances of the baby’s survival and successful delivery,” Ms Ogega explains.

She emphasises that their involvement with babies does not end with once the babies are delivered at formal health facilities.

“We also track the babies progress and growth  from  day one  until they are six weeks old,” she explains.

FULLY SUBSIDISED

“That is done at the first level of the government’s child care initiative. The second level involves continuously tracking the children’s growth up to five years,” Ogega adds.

Since the free maternity programme is fully subsidised by the national government, the department is responsible for ensuring that accurate records of deliveries in every government facility are kept and regularly updated.

“This is to assist us in getting reimbursements from the national government for expenses incurred in this programme,” she says.

Ms Ogega reveals that the department also works with the national immunisation services to compile the data and information necessary to conduct properly planned campaigns.

“We also link up with the immunisation services to ensure that they have accurate data on areas that are yet to be covered by immunisation programmes…Our data constitutes a major part of their campaign strategy,” she says.

And it is through  their delivery and health tracking records that the immunisation services department is able to calculate, using the population and age groups of a specific area, whether the children there are due for a particular vaccine or not. 

“It also makes it easier for them to track the population of immunised children as well as the progress of their health through our tracking system,” Ms Ogega explains.

But despite the remarkable improvements, the coordinator concedes that the antenatal care programme has its challenges.

“Our biggest challenge is lack of funding,” she says.

This, she explains, results from delays in the disbursement of funds by the national government at the beginning of the fiscal year.

Her view is echoed by the county Minister for Health, Ms Sarah Omache, who adds that the funding gaps created by delays in the disbursement of funds lead to poor service delivery.

“However, we have informed the national government of the situation at the county level.

“They are in the process of streamlining procedures to ensure that health services in the  counties continue running smoothly, without hitches caused by disbursement delays,” Ms Omache told DN2.

According to Ms Ogega, the delays sometimes result in shortages of essential medical supplies, including drugs, as well as non-pharmaceutical items.

As to whether mothers are consistent in visiting the health facilities four times before they deliver, Ms Ogega paints a less-than-rosy picture.

“The 97.7 per cent compliance rate we recorded in 2014 is for first-time visits to health facilities,” she says.

“A possible reason for the decline in consistency of such visits by expectant mothers is that they become relaxed that everything is okay once the first visit and related tests indicate nothing alarming about the pregnancy,” she says, adding, “They become complacent, secure in the knowledge that they are safe, going by the results recorded during their first visit.” 

However, she laments, what many of the women who sit back after the first visit don’t understand is that they need to be seen by the medical personnel at least four times to ascertain that the pregnancy is progressing well, as well as having checks on their vital signs and the baby’s health.”

She blames most of the complications that occur during delivery on mothers who attend the first antenatal clinic session, who, upon being told that they are healthy,   go and stay at home, only to resurface when they are about to deliver. 

She says that, ideally, women should visit a healthy facility for a check-up as soon as they discover that they are pregnant.

“This will enable us to detect possible complications and therefore, undertake preventive and curative measures immediately,” she offers.

“When they do this, we can detect conditions like HIV and put the mother on the required prevention of mother-to-child-transmission (PMTCT) regime to prevent her from passing the virus on to her unborn baby,” Ms Ogega points out, adding that a woman’s blood clotting system is also analysed during these visits  to determine what kind of assistance she will be given when during childbirth, should the need arise.

“This is because some women bleed more heavily than others, necessitating blood transfusions to restore their blood to a healthy level,” Ms Ogega explains.

“The visits are, therefore, necessary to ensure that we compile a comprehensive medical file of the expectant woman, including any changes in weight, blood pressure and blood status, which enables us to plan in advance for her delivery,” she points out.

The medical personal also use other interventions to ensure that the pregnancy does not endanger the life of the mother or child.

Ms Ogega says most complications that occur during delivery stem from the negligence of mothers to complete the required antenatal care visits.” 

“They visit a health facility just once, perhaps hoping to please the medics that they have fulfilled the conditions of antenatal care. But once they are given a clean bill of health, a considerable percentage do not attend the remaining three visits,” says Ogega.

Alluding to this trend, she says, “This could explain the disparity  between a compliance rate of 97.7 per cent for expectant women’s first-time visits to the clinic and 54 per cent for fourth visits.”

She says despite this negligence of the women’s part, they do their best to facilitate a delivery when a complication occurs.

“Some women come when the complication is beyond help, and it is such cases that often result in the death of the mother or child. In serious cases, both the mother and the child die, she says.

Ms Ogega is quick to absolve the country’s health system from blame in the cases of of those who  deliver at home.

“For the record, maternity services are free in the country, and fully subsidised by the national government,” she asserts. “They cover consultancy, medical examinations and lab tests, and  also cater for ambulance charges in case the expectant mother  develops complications and has to be rushed to a hospital that can handle the emergency.”

Meanwhile, Ms Omache says that no woman in the country should take the risk of delivering at home.

“There are adequate medical facilities in the county. In fact, there are 146 state-operated facilities that are offering free maternity services. This translates to a government-run facility for every five kilometres. Our women no longer have to travel long distances to access maternity services,” she says.

“We are, therefore, encouraging women to take advantage of these services and visit the nearest health facility for the crucial assistance they require to deliver their babies in the healthiest and safest ways possible,” she said.

For now, the outlook on safe deliveries for women in Kisii County is bright, hopes and the promise of better chances of mother and child survival.

“We hope the national government will channel more funds to the county reproductive health services department to enable us to provide even better services,” she says.

“Infant mortality used to be a problem in the past but we are now able to assist mothers to deliver in the best conditions possible,” Ms Omache says.

“There is real potential for making it a negligible threat to our county’s babies and children in the near future,” she concludes.

So even as the county grapples with the many challenges of providing quality healthcare for its more than 3 million residents, as far as child and maternal health go, it has made good use of the free maternity services to achieve remarkable results.