UNDP, CRAWN Trust push for increased access to maternal, child health services


A pregnant woman in eastern Uganda receives the sort of prenatal care that UNICEF says ...
A pregnant woman in eastern Uganda receives the sort of prenatal care that UNICEF says can prove crucial to a newborn's chances of survival. PHOTO | COURTESY

In Summary

Other emerging issues highlighted in the study include:
  • Perennial delays in settlement of outstanding bills with Kenya Medical Supplies Authority (KEMSA) frequently lead to stock out of commodities and consequent interruption of service delivery.
  • Limited access to publicly funded services and limited access to insurance coverage; Maternal Child Health clinic locations and hours that are not convenient for clients
  • The mix up between the Nairobi Metropolitan Services (NMS) and Nairobi County Government has resulted in poor flow of funds and thus limited services for women.
  • NHIF is undergoing review which hasn’t also been transparent and there is an urgent need for CRAWN Trust and CSOs to engage more strongly.

Lack of access to maternal, child health services as well as poor provider attitudes have largely contributed to maternal deaths in Nairobi.

Also Read: Pumwani Hospital says nurses eventually attended to woman who delivered outside their gate

A policy brief from UNDP and Community Advocacy and Awareness (CRAWN) Trust sought to shed light on contributors and identify, measure and highlight gendered impacts in the health sector, specifically on maternal and child healthcare.

“Over the past 9 months with the advent of COVID-19, service statistics show a declining trend on utilisation of maternal and child health (MCH) services such as delivery, antenatal care (ANC) attendance and child immunisation in health facilities,” the report reads.

The brief was undertaken under a project titled ‘Health Rights Advocacy for Women and Girls’ which is part of the UNDP SPAIS (Strengthening Public Accountability and Integrity Systems) programme with activities targeting Nairobi County.

Maternal mortality rate (MMR) estimates in Nairobi county were noted to be 212 per 100,000 live births compared to 362 per 100,000 live births nationally.

Additionally, MMR in the informal settlements was found to be alarming and more than twice the national average with research studies reporting 706 maternal deaths per 100,000 live births.

The infant mortality rate in the county stands at 55 per 1000 live births while the under-five mortality rate stands at 72 per 1000 live births.

Poor health-seeking behaviour

Data shows that most maternal deaths occur among women who are young, married, with low levels of education and those having at least two births.

Previous studies found that maternal deaths in Nairobi were were also due to poor health-seeking behaviour, delays at the household level in seeking care, poor referral mechanisms between facilities, poor provider attitudes, and lack of skilled human resources.

HIV/AIDS was the main contributor to mortality and morbidity in Nairobi with prevalence at 6.1% in the county which is 35% higher than the national prevalence.

A World Health Organisation report found that in the absence of any intervention, transmission rates range from 15% to 45%.

“This rate can be reduced to below 5% with effective interventions during the periods of pregnancy, labour, delivery and breastfeeding,” the report adds.

With teenage pregnancies on the rise, new adolescent and youth HIV infections and harmful practices such as child marriages are taking place.

According to CRAWN Trust and UNDP, there is need for mitigation efforts to be scaled up.

They further call for ensuring universal access to youth friendly quality reproductive health services and information by 2030.

NASCOP and other HIV programmes have also been urged to take lead coordinating partners and ensure that the most vulnerable populations infected and affected by HIV continue to receive treatment and services even as donor funding to support HIV programming declines.

Nairobi ranks top three with high stunting caseload

In terms of nutrition, previous studies found that stunting–which had remained stubbornly high over the past two decades–was on the decline.

However, Nairobi County remains among the top three leading counties with the highest caseload of stunting at 24%, according to the SMART survey of 2019.

“Stunting reflects failure to receive adequate nutrition over a long period of time and is affected by recurrent and chronic illness. Height-for-age, therefore, represents the long-term effects of malnutrition in a population and is not sensitive to recent, short-term changes in dietary intake,” a report from the Kenya Demographic and Health Survey found.

Acute malnutrition (3.9%) in the informal settlements was also highlighted as a concern due to the high population density.

Given that maternal nutrition has a direct impact on a child’s survival, CRAWN Trust and UNDP note that Nairobi County requires aggressive awareness campaigns and outreaches in the community to educate households.

The households are said to be lacking information on the importance of complementary feeding, maternal nutrition, deworming, Vitamin A supplements, maintaining balanced diets and 6-months exclusive breastfeeding for newborns.

With the Universal Health Coverage Day that was celebrated globally on December 12, 2020, the policy brief avers the importance for Nairobi County to address the needs of the majority who reside in informal settlements and who are at risk of developing adverse mental and physical developmental outcomes.

“This is critical if Kenya is to meet the upcoming 2022 target of achieving UHC for all Kenyans and also to achieve the upcoming sustainable development goals 2 and 3 of zero hunger and good health and well-being,” the report adds.

In addition, CRAWN Trust and UNDP are pushing for strengthened financing of community efforts to promote maternal, neonatal, and child health.

Corruption scandals

Their policy brief further criticises the government over widespread scandals and mismanagement of public resources.

According to the policy brief, the scandals have resulted in health facilities lacking essential equipment, drugs, PPE, adequate staffing and friendly customer service needs.

“This should be put to a stop and citizens need to demand for the services they deserve. As a low-middle income country, and diminished donor funds, the Government owes its citizens access to comprehensive reproductive, maternal, neonatal, child and adolescent health care services in all health facilities,” the report adds.

UNDP and CRAWN Trust is calling for more advocacy initiatives to demand accountability in healthcare spending and service delivery.

With an imminent health worker strike looming , the non profit firm and its partners have called on the Government to take serious action towards addressing impunity, abuse of public office, lack of transparency and lack of accountability.

This they say will ensure that women and children get quality services as outlined in the Ministry of Health Charter.

“Citizens who remit their hard-earned taxes have every legal and moral right to demand for timely, quality, affordable and accessible services when seeking healthcare,” the statement adds.

The policy brief was informed by data generated from national and county policies and strategies; analysing primary data from key policy decision-makers and player’s interviews to assess the key entry-points for justifying the need for investing in Maternal Child Health.

It focused on attainment of the right to health, adequacy of health financing, quality of care and availability of services among others.

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