UN health programme counters maternal, infant mortality in Kenya’s high burden counties
Findings of a five year health programme carried out by the United Nations (UN) show a significant increase in the provision and uptake of life-saving health services. The $21 million UN H6 Joint Programme on Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) also shows improved access and quality of integrated maternal health services, as well as services for those living with HIV and survivors of gender-based violence (GBV)
between 2015 and 2020. The programme was implemented in the country’s highest burdened regions for maternal and infant mortality including Isiolo, Lamu, Mandera, Marsabit, Migori and Wajir.
The UN H6 partnership is made up of UNFPA, UNICEF, UN Women, WHO, UNAIDS and the World Bank who together, are directly mandated globally to provide leadership in the health of women, children and adolescents.
The report shows that from 2015-20, the number of women who utilised antenatal care services increased by over 32%. Access to skilled attendance at birth also increased by 30% as a result of sustained community-based advocacy, improved infrastructure and the provision of health equipment, by the UN H6 Joint Programme. The programme also supported extensive training and mentoring of health care workers across the target counties on reproductive, maternal, new-born, child and adolescent health, providing them with requisite skills and knowledge to respond to emergencies at primary health facilities, and to diagnose and refer patients adequately.
Based on an in-depth evaluation of programme interventions carried out in the six counties, the report found that the number of women who received HIV testing and counselling at antenatal clinics increased gradually from 2015 to 2020, with Lamu County recording the highest increase (from 40% to 99%) in proportion of those tested. This is a critical milestone in achieving Kenyan’s target to eliminate mother-to-child transmission of HIV. In addition, the number of GBV survivors who sought health services increased, with Migori county recording the highest increase of 50%.
Whereas the six target counties bear the biggest burden of maternal, new-born, and child deaths, paid health services remain inaccessible to many, due to high poverty levels. The WHO standard for countries is that there should be a health facility within a five-kilometre radius, but in most of the focus counties, facilities are 50-200 kilometres apart. Strengthening of institutional capacity has stimulated an increase in county spending on health: from an average of 22 percent to 26 percent between 2015 and 2020, representing an 18% increase in budget allocation. Private sector partnerships have also availed additional resources for investment in critical programme areas.
“The programme has shown that a little investment done right and done smartly, can change health
outcomes, and has motivated investments by the counties themselves in these critical areas,” said
UNFPA Representative for Kenya Dr Ademola Olajide. Insecurity remains a challenge to the delivery of quality maternal and other health services in the counties of Mandera, Wajir and Lamu, particularly due to the high turnover of trained health care workers. In Isiolo and Marsabit, socio-cultural barriers have led to the low utilization of key interventions such as maternity shelters, while traditional birth attendants threaten the demand for
access to skilled delivery services.
The COVID-19 pandemic has significantly affected access and utilisation of essential health services including RMNCAH, HIV and GBV services, as witnessed since March 2020 when the first case was identified in Kenya. For Kenya to achieve Universal Health Coverage (UHC), in line with the President’s Big Four agenda, the most vulnerable in the country need to be reached with urgency. The report concludes that continued resource mobilization, both domestic and external, building strong partnerships and leveraging existing programs to build the capacity of health care workers can help sustain gains made in reducing maternal and neonatal mortality in the high burden counties. Where access is poor, owing to regional or other barriers, encouraging initiatives that deliver services at the community level will also help to achieve health gains in a cost-effective manner.
It is evident that a lot of progress has been made in the high-burden counties in the past five years especially due to the contribution by the UN H6. However, the report also underlines the unfinished work to sustain the access and delivery of integrated quality RMNCAH, HIV and GBV services. “We call on partners to support and leverage on the gains made in the last five years to ensure targeted groups in the six counties and communities continue to enjoy the RMNCAH, HIV and GBV services,” said WHO Representative to Kenya, Dr Rudi Eggers. This is also central to securing health for all, through universal health coverage,” he added.