Last month, Child.org travelled to Garissa, Kenya, to collect critical data about the current state of maternal and child health in the region. Martina Gant, Child.org’s CEO, reflects on the insights she gained whilst working with Garissa’s County Health Management Team and visiting health facilities in the region.
At the end of June this year I had the privilege of travelling to Garissa for the first time, after working in Kenya for over 16 years. It was a great opportunity to see a part of Kenya that I hadn’t experienced before, especially as this is a new region for Child.org’s Team Mum programme.
It was unlike any area of Kenya I am familiar with; culturally and environmentally. It was a fantastic opportunity to experience the diversity of Kenya to its truest degree; having lived here with my family for 9 years, it was a great reminder that there is still so much more to see and experience.
During my visit I had the opportunity to meet with the County Health Management Team and to hear their priorities and commitments to women and babies. I also learned that they have lost a significant proportion of their income because of the aid cuts this year.
I visited a level 5 teaching hospital, the highest public health referral facility within the county, with a newborn intensive care unit, meeting the incredible doctors and nurses managing difficult caseloads in challenging environments with competency and grace. I also visited a level 4 facility showing impressive initiative with new financing opportunities, innovating ways to incentivise women to deliver within facilities.
Access to healthcare
What I learned through my visit, thanks to the insights shared, is that one of the most significant challenges affecting the maternal and neonatal health outcomes in Garissa is that of access to care: getting women to utilise the services available.
The quality of care that I saw (albeit in only the two facilities I visited, which were close to town and well managed and maintained) was good. But home deliveries are still favoured by many women for multiple reasons of which the two most frequently referenced were the distances to clinics and a fear of interventions during birth.
Mama taxis to tackle accessibility barriers
In Medina Sub-County Hospital, the Level 4 Facility, Farhia Ahmed (Senior Nurse) explained that women struggle to travel up to 15km to the facility for delivery. For context, women in Narok (another region where Team Mum is operating), women have to travel over 100km for comparable services. In Garissa, there are fewer public transport services available in comparison to Narok. This means communities have to rely on taxi services, which are unaffordable to many.
To manage this, Farhia and her team have introduced a mama-taxi service, using funds available from the new Facility Improvement Finance system (FIF). The facility has identified a service provider (a taxi driver) who can be called when a woman is in labour, or during an emergency, and then will be paid by the facility and not by the woman/family. The number is given out during antenatal care appointments.
Mama kits to incentivise giving birth in hospital
Another innovation, funded by the same system, is the provision of mama kits, to incentivise women to deliver in a hospital. These kits contain items such as soap, mosquito nets and a basin. We know from first hand experience that incentives like this really work as we used them to great effect on the Team Mum pilot. For us, these were costly and unsustainable, but the Medina Hospital is demonstrating that this is sustainable locally.
They are using revenue received through FIF (they are paid by the government for every delivery performed at the facility, read more on FIF here) to pay for these incentives. The incentives are working as they have seen a significant increase in the number of deliveries per month (from 10 in March this year, to 51 in May) and which is therefore further increasing their revenue through the FIF system.
Delays in accessing life-saving interventions
The other challenge highlighted was the fear around interventions during birth – such as caesarian sections – and specifically the impact that of male decision-making has on pregnant women seeking care. The dynamics of gender in Garissa are that women are heavily protected by men within the home, meaning that most decisions around healthcare are made by men and not women. Women often lack the autonomy to seek life-saving interventions during pregnancy and birth which can cause critical delays with accessing care. This delay has been cited as a key factor behind Garissa’s high maternal and neonatal mortality rates. Once a decision has been made to proceed to hospital, or with a caesarian section, it’s too late.
Team Mum in Garissa
Team Mum is designed to reduce such delays. By providing pregnant women with information around danger signs in pregnancy, birth and for newborns, the project improves awareness of when seeking care is critical. We also work with husbands and male partners to provide the same awareness and on how to prepare for birth and emergencies.
Our work drives demand for life-saving services from women and communities. Alongside that, our team has expertise in supporting facilities and health management teams with identifying strengths and weaknesses at facility level, and on building resilient health systems based on contextual needs.
We are just getting started in Garissa. It was fantastic to see Team Mum operating in such a different environment and adapting the programme to a different culture and context. We’re looking forward to building upon the great work already happening in the county, and supporting Garissa with getting more women and babies the life-saving care they deserve.
Thank you for supporting The Big Give
We have been able to launch Team Mum in Garissa thanks to everyone who contributed to our Big Give campaign in December 2024. With the support of our patron Melvin Benn at Festival Republic through their pledge, our Champion funder at The Coles Medlock Foundation, we were able to match the donations from over 100 of our supporters, raising £83,470.
Not only have we been able to extend the reach of our work and support a county experiencing significant challenges in Maternal and Newborn Health, but we’ve also had the opportunity to adapt Team Mum to a new context and to learn and develop new expertise in our team. Thank you to all of you that supported the campaign and look out for plenty more updates coming soon.