How maternal health programmes are changing lives in Vihiga, Kakamega counties
By Lilian Kaivilu
To many mothers, giving birth is a nightmare. The entire pregnancy journey is not any better. With limited access to resources, health facilities and basic education regarding reproductive health, most of these mothers opt to give birth at home, thus increasing their chances of maternity related complications.
Nelly Achakulwa, a resident of Elwesero in Kakamega County knows this too well. The mother of five says she delivered her first four children at home. “I gave birth to my four children at home. The pregnancies were easy hence I did not see any alarm. That is why I opted to give birth at home,” says Achakulwa.
According to the mother of five, she opted to go to the hospital due to the difficult times she experienced during pregnancy. “I had very bad backpains. I could neither bend nor stand. Because of fear of further complications, I opted to come to the hospital,” she added. Achakulwa who works as a farmer says she experiences sharp backpains since giving birth to her last born on March 19, 2019.
Priscilla Oparanya, Kakamega First Lady attributes home deliveries to fear among most mothers. “Previously, most women did not give birth at health facilities for fear of insults from nurses. As a result, they preferred the help of traditional birth attendants (TBAs) while giving birth,” said Mrs Oparanya. But with TBAs now serving as birth companions to pregnant mothers, the First Lady says cases of home deliveries have reduced significantly. She hopes to be remembered for changing the lives of mothers in the county by ensuring that all women give birth in a health facility, with the help of a skilled birth attendant.
Oparanya Care, a programme introduced by Kakamega Governor Wycliffe Oparanya seeks to encourage mothers to deliver in health facilities. Through cash incentives, the mothers in Kakamega county earn Sh2,000 when they give birth in the hospital and a similar amount every time they attend post natal visits to health facilities.
Jessica Koli, the reproductive health coordinator in Kakamega says the county now records 66% skilled deliveries, a move she attributes to efforts by community health workers CHWs). According to her, the Oparanyacare programme is operational in 25 health facilities across the county and targets needy mothers by encouraging them to give birth in a health facility. She says the women are paid Sh2,000 for the fourth antenatal clinic, Sh2,000 after a skilled delivery, Sh2,000 after taking their child for immunization at six weeks, Sh2,000 upon post natal clinic visit at six weeks and another Sh2,000 for clinic visit at 18 months.
So far, 30,107 mothers in Kakamega county have benefited from Oparanyacare programe with a total enrollment of 45,325 mothers across the county. Koli, however, calls for more partnerships, especially in skills training for community health workers.
Magdalene Ingaji is a 22-year-old mother of one. She delivered her baby at Elwesero health centre in Kakamega county after two days of labour. “I was told I had long distress. After the two days, I was transferred to Kakamega Teaching and Referral Hospital. Just before getting to the theatre, I was given a form to sign. I did not know what it was,” says Ingaji.
Although the entire procedure was paid for under Oparanyacare, the mother of one says she would prefer to be informed of any procedures being performed. Ingaji is just one of the many mothers who lack basic information on medication and medical procedures that they undergo while pregnant or during delivery.
While mothers across the country are now able to get better reproductive health services, information sharing to mothers during pregnancy, labour and after delivery is key. Veronica Musieka, the reproductive health coordinator in Vihiga county says healthcare workers must ensure that they inform mothers of every single step of the treatment. “If you are giving a mother a certain drug, injection or a procedure, make sure you inform her. Also, get her consent before the procedure, after a proper explanation,” she advises.
Even when administering contraceptives, Musieka insists on proper education beforehand. According to her, contraceptives uptake is estimated at 58 percent in Vihiga County. “We always have counseling before we give the contraceptives. But the uptake of the commodities remains voluntary. We what we do best is to ensure that we provide the key messages on presentation of pregnancy and family planning.” Musieka, however, cites a challenge by some men who still want their wives to have as many children as possible. According to her, the implant is the most used family planning commodity among women in Vihiga county. The implant has less side effects compared to other methods.
A report by Access to Medicines Platform done in 2018 showed a drop in access to sexual reproductive health commodities in Kenya; from 46 percent to 36 percent in the previous year. In order to address the challenges of commodities stockouts, inadequate community education and inaccessibility to youth friendly services, the report recommends adoption of a multisectoral approach in the provision of health services and commodities, especially in the hard to reach areas.
Sexual and Reproductive Health Commodities: Availability, Afordability and Stockouts (Kenya 2018) report further reccomends improved supply chain, accurate and timely quantification client education and outreach as well as increased budget allocation for the purchase of sexual reproductive health commodities.
In Vihiga County, more mothers are now giving birth in hospitals, thanks to Ottichilocare, a maternal health programme that encourages women to attend all antenatal and post natal hospital visits as well as have skilled deliveries.
The Ottichilocare programme is now operational in 21 health facilities in Vihiga County and has so far registered over 2,000 women. In order to improve service delivery under this initiative, the county has trained 180 healthcare providers on emergency obstetric and neonatal care. According to Musieka, the county has seen about 800 mothers attend their 4th antenatal visit while 150 mothers have given birth under this programme. For first antenatal visit, the county has paid about 900 mothers, 780 mothers for fourth visit and is now preparing another first visit payment and again another payment for those who have had skilled deliveries.
Bernice Isangari, 31, is one such beneficiary. The mother of four delivered the first two children at home. “But for the third one, the pain was too much. As a result of fear, I opted to give birth at a health facility,” says Isangari.
Isangari who is expecting her fifth child now joined the Ottichilocare programme late last year. “I now understand the dangers of giving birth at home. I will give birth in the hospital.” Through the programme, she receives Sh1,000 whenever she attends ante natal clinics. “I have so far received Sh1,000 for each ante natal clinic visit. This money has helped me pay for transport to the clinic as well as buy fruits.”
Vihiga County governor Dr Wilber Ottichilo is optimistic that the maternal and child health programme will ensure a healthier and more informed population. “Through the Ottichilocare, I believe we will have mothers who are more informed about their health. The programmes has also a component on family planning. Mothers have to understand the essence of family planning and the need for them to recover fully after child birth. One of the goals of Ottichilocare programme is to encourage people to have small families that they are able to manage,” said the governor.