The CICF Kakamega workshop was held on Wednesday 29th April 2015 at Golf Hotel. It was part of Intra Health County training for the IHRS (a tool being used as a database for all the trained health workers in the county). It was a good opportunity for the CICF invited guests as well as the County partners who listened to the CICF funding opportunity prior to the IHRS training from mid morning.
A brief background on Kakamega County and its maternal and neonatal health challenges will answer the question why it is one of the focus counties for the DFID funded County Innovation Challenge Fund.
Kakamega County is located in Western Province of Kenya and constitutes 9 constituencies (Malava, Lugari, Mumias, Matungu, Lurambi, Shinyalu, ikolomani, Butere and Khwisero. Kakamega has a projected population of 1,929,401 in 2015, second only to Nairobi, of which 57% are living in poverty leading to high infant mortality rates and many diseases including HIV/AIDS.
Kakamega has high fertility rates among women as shown by its highest percentage household size of 4-6 members at 43%. 23% of the population are women of reproductive age resulted in a child rich population where 0-14 year olds constitute 47% of the total population. Children under 5 years of age make up 17% of the population. Nevertheless, the infant mortality rate is very high at 35 deaths per 1,000 live births and the under five mortality is 52/1000 live births. This is a big improvement from a an infant mortality rate of 77/1000 in 2009.
The County government of Kakamega has had achievements in addressing challenges of maternal and newborn health. Among the initiatives implemented has been the OparanyaCare program where a cash token is given to mothers when they deliver at health centers. Birth companion initiatives have been rolled out in several districts including Lurambi, Navakholo, Matungu, Mumias East and West. In addition, the free maternity services introduced by the government in 2013, has lead to increase in the number of expectant mothers seeking delivery in health centers. 61% of the expectant mothers delivered at the health facility in 2014.
During the workshop in Kakamega, Dr. Brenda Baraza Makokha, the immediate County Director of Health and the current Chief Officer of Health outlined the maternal and neonatal County priorities as follows:
- Increased skilled delivery
- Increasing the number of women using modern Family Planning methods in the long term. Current usage is at 58% of married women.
- Increased facilities providing specialized and comprehensive care
- Equip health facilities with MNHC equipment
- Capacity building of health workers and the community health volunteers
- Maternal perinatal death audit reviews and response
- Demand creation of health services
- Scaling up of birth companions in all the 12 sub counties (an increase from the current 5)
- Strengthening referral systems from communities to health facilities
One of key successes has been the Oparanyacare initiative lead by the county Governor Hon. Wycliffe Oparanya. The initiative is working with Amref to increase the demand for improved maternal health services by the community. One of the ways in which demand for the services is being addressed is through training of Traditional Birth Attendants (TBAs) being reoriented as birth companions who are guiding the mothers to the health centers.
She invited the private sector, CBOs, CSOs, NGOs to join the county in addressing the maternal and neonatal health challenges in the county. Some of the challenges that presented partnering opportunities with the county government were:
- The disparity in the number of expectant women seeking healthcare in the first trimester (96.4%) as compared to those seeking healthcare from a skilled health attendant in the last trimester at 45%.
- Increasing the percentage of expectant mothers seeking delivery services from a skilled health provide from 48.6%.
- Increasing the number of expectant mothers delivering in a health facility from 47%.
- Increased uptake of family planning for married women from 60% as well as closing the unmet need for family planning at 20%.
Some of the barriers preventing women from seeking healthcare services were:
- Training of TBAs to become birth companions
- Improved perception of health workers by the community
- Involvement of males in reproductive health issues
- Inadequate specialized staff and health facilities
- Addressing the issue of frequent commodities stock outs
- Poor community to health facility referral system
- Poor healthcare providers attitudes