Thursday, April 11, was the International Day of Maternal Health and Rights. The World Health Organization (WHO) set aside this day every year to bring to the attention of everyone the plight of women and girls and as a call to action to address a woman’s right to high-quality, respectful care before, during and after pregnancy.
Also on this day, Kenya launched the “Lancet Global Health Commission on High Quality Health Systems in the SDG Era” — a ground-breaking report that stresses the need for high-quality health systems that optimise health by consistently delivering care that improves or maintains health, being valued and trusted by all people and responding to changing population needs.
When I graduated from the University of Nairobi a few years ago, I was full of joy, knowing that I was going to deliver babies and bring the much-anticipated joy to mothers and their families.
But this was not to be: I witnessed more deaths than I ever imagined in the health facilities in hard-to-reach areas in Kenya, South Sudan and elsewhere in Africa.
I cried most nights. We were few workers and the health system was broken down. We had no lights at night, no running water, no blood banks, no ambulance, not even gloves or other basic essentials that we often take for granted. Here I was, trusted to save lives, but unable to save much!
I was heartbroken.
Then there was the culture that women were not allowed, or given the opportunity, to be heard when they visited health facilities. Besides, the services that they received were basically routine — to be seen, palpated, delivered of their babies and discharged.
They were passive recipients of care with no right to information, to question or to contribute to their healthcare.
They were rural women with little or no education to question our competency. I doubt if they even knew they had the right to healthcare.
It was at that point that I decided maybe, just maybe, if we had more frontline health workers it would make a difference. I became a trainer. I started training and upgrading programmes to improve skills and competences for frontline health workers. Through eLearning, midwives did not have to leave their clients as they studied.
I published a policy voice, Nursing the Future, eLearning and Clinical Care in Kenya, to share lessons and experiences with institutions and adopt this model of training.
Over the past decade, I have read the most beautifully written reports about the numbers of women and newborns dying everywhere from preventable causes.
It’s only last year that the Ministry of Health launched one of the most heartbreaking reports, “The Confidential Enquiry into Maternal Deaths in Kenya”, which stated that nine out of 10 women in Kenya die as a result of poor quality of care during pregnancy and delivery.
Over time, I have heard in various forums that we must create demand for services for the women and citizens to utilise. But what we often mean is that women and citizens should utilise services offered, no matter how poor the quality.
We plan projects, talking of inclusivity but, more often than not, we never include the women’s and citizens’ needs and ideas in them.
Women and girls must be key stakeholders like all others — policymakers, health workers, academia, private sector and civil society groups. We should not continue to force poor quality services on women and girls, and people in general, without listening to them.
For close to a year, I have led the collection of voices for What Women Want, a campaign that sought to hear from women and girls their definition of quality healthcare. There has been both a sense of wonder, some scepticism and deep appreciation that they are even being asked this simple, yet profound, question: What is your top priority for quality reproductive and maternal healthcare services?
What is the answer to this? The Lancet report, more so its “People’s Report” recommendations, is very important. But we have seen equally compelling reports go nowhere.
Our country has embraced universal health coverage as a key pillar in the ‘Big Four Agenda’. Underlying UHC are basic principles of equity and quality, both critical for quality health outcomes if the UHC investments are to be realised.
Ms Nguku, the founder and executive director of White Ribbon Alliance for Safe Motherhood in Kenya, is a People Voice Advisory Board member of the Lancet Commission on High Quality Health Systems in the Sustainable Development Era. [email protected]