Maternal Health in Kenya - Case Study Example

Maternal health in Kenya Name of the Student: Name of the Instructor: Name of the course: Code of the course: Submission date: Improving maternal health in Kenya and what global practices can the government adopt Introduction It has been cited that on a global spectrum, a woman dies in every minute as a result of complications linked to childbirth. Additionally, about 500,000 women die annually as a result of maternal causes with 99% of these deaths being experienced in the developing countries (Ochako et. al., 1). This has been the case in Kenya which has been credited of having high maternal mortality ratio (MMR) with inadequate interventions being formulated and implemented in this country to curb this trend in the past several decades (Tomedi et. al., 152). Subsequently, the core purpose of this paper is to investigate the diverse mechanisms which can be primed in Kenya aimed at enhancing maternal health and as well as exploring what global practices can the government adopt towards the achievement of this goal. This is against the backdrop of the free maternity in public hospitals which was promised by the new government which has been seen as a key intervention towards minimizing MMR in the country. In regard to the scope, this paper will be primarily focused on Kenya as part of the wider sub-Saharan region which has been cited as being confronted by diverse problems related to maternal health. In this case, other regions in sub-Saharan Africa will not form part of the discourse in this analysis although some limited practices from other regions will be borrowed in order to gain a comparative perspective as evident in the subsequent section. Background of Maternal health in Sub-Saharan Africa Diverse researches have revealed poor maternal health in this region. This is best epitomized with one out of 16 women dying in the course of their pregnancy on during childbirth in this region. This reveals a greater risk which is 175 times higher than that in the developed countries which has been put at one in 2,800. Additionally, more women (approximately 9.5 million) in Sub-Saharan Africa have been estimated to suffer from pregnancy related illnesses, near-miss events (1.4 million) while other potential detrimental consequences after birth (Filippi et. al., 1536). This phenomenon of poor maternal health in Sub-Saharan Africa has been aggravated by diverse factors. These are best epitomized by the fact that various governments in this region have been reluctant to enhance nature of maternal health in their various countries, mostly related to employment of trained staff as well as equipping the health facilities. This has seen a great variance of anti-natal care (ANC) in these countries with Pell et. al., (2) fortifying this fact. These authors determined that there is a wide variation of ANC attendance across Sub-Saharan Africa whereby although 71% of pregnant women register attendance of formal ANC at least ones in the course of their pregnancy, only 44% of these women attend four or more times. This phenomenon is apparent in Kenya with data from the Kenya Demographic and Health Survey (KDHS) revealing that despite the overall coverage of ANC remaining high in Kenya, majority of the women have been revealed to attend their first ANC late in their pregnancy (Ochako et. al., 1). Additionally, the efforts towards the realization of enhanced maternal health in Sub-Saharan Africa have been constrained by elevated competition in governments’ prioritizations. This is with other epidemics like HIV/AIDs as well as Malaria outbreaks which are prevalent in this region among other health challenges providing key challenges with the policies to enhance maternal health facing serious competition from the policies to address other health issues outlined above. As a result, the rate of decline of MMR has been very slow in this region with data from the World Health Organization (WHO) indicating that in majority of the low-and middle income countries (LMICs) mostly in Sub-Saharan Africa, the overall annual rate of decline in MMR is less than 1% and even in some countries like Nigeria, Mozambique and Swaziland register increasing rates of MMR (Finlayson and Downe, 1). The Kenyan Situation As noted in the preceding section, Kenya is confronted by diverse challenges in maternal health, mostly in regard to the delivery care component. Magadi (172) identified several factors which contribute to this phenomenon. Firstly, despite the fact that Kenya prides itself of almost universal ANC, less than half of all the deliveries in this country occur in health facilities. Women living in the rural areas are the most affected category in this case due to the inaccessibility of health facilities in these regions. Secondly, there have been the issues of affordability of the ANC services mostly among the women in the rural areas where there are high poverty rates as well as in the slum areas which are confronted by similar economic challenges. The instigation of cost-sharing for particular health services (excluding promotive and preventive services such as ANC by the Kenyan government since 1989 had previously been perceived as a core restriction to the poor women from rural areas and slum environments from seeking delivery care. Nonetheless, the introduction of free maternal care by the new government in Kenya as noted in the preceding section is seen as a key step towards addressing this problem (Magadi, 172). Lastly, it is imperative to note that there is high prevalence of HIV in parts of Sub-Saharan Africa, a phenomenon which is apparent in Kenya (Birungi et. al., 143). This further complicates the access to maternal health, mostly among pregnant teenagers who are the most vulnerable in this case. As a result, they are confronted with diverse difficulties in accessing relevant services for instance, ANC, prevention of mother to child transmission (PMTCT) of infection as well as access to skilled attendance. Moreover, the minimal age of the teenage mothers also places them in a vulnerable situation where they may have to deal with disapproving healthcare providers and those teenagers who are both pregnant and living with HIV are confronted with an extra challenge whereby they might face discrimination and stigma in the healthcare facilities (Magadi, 172). In this case, the women living in the rural areas as well as those in the slums are the most vulnerable to maternal mortality based on their poor economic capacity as well as inaccessibility of both the health facilities as well as trained healthcare providers. Additionally, the pregnant teenagers including those living with HIV are another vulnerable group who are confronted with diverse challenges ranging from disapproval of the healthcare providers, discrimination and stigma. There are diverse consequences of this phenomenon in Kenya. Firstly, results from the study by Ochako et. al., (1) revealed that due to the disapproval of the healthcare providers and discrimination of the pregnant teenagers, a large percentage of these young women fail to seek ANC in the course of their first trimester as it is underpinned in the WHO recommendations. This thus affects the type of assistance that they receive during delivery and are bound to experience extensive complications and increase the likelihood of their post-delivery morbidity and even death. Thus, this greatly contributes to the increase of MMR. Secondly, the economic marginalization of the women living in the slum areas and those in the rural areas is bound to contribute to diverse maternal outcomes and increase MMR. This fact is revealed in the study by Izugbara and Ngilangwa (1) who showed that in the context of the slums, poverty is key causing undesirable maternal outcomes among women through not only inhibiting their access to quality maternal services and nutrition but also exposing them to exceedingly heavy workloads in the course of their pregnancy as well as inhospitable and poor treatment by the service providers which has implication of increasing the MMR among women dwelling in the slum area. This is also evident among women living in rural areas. Implemented programs There has been a wide alley of programs which have been implemented in Kenya aimed at enhancing maternal health in the country. This after maternal health lagging behind among primary care strategies which have been implemented in Kenya since independence aimed at impacting on child health. This is best epitomized by Maternal Health and Safe Motherhood Programme which was established in 1987 geared towards ensuring that women are health in the course of their pregnancy and even after childbirth (Owino, 82). Additionally, Kenya has implemented other programs in the recent past aimed at the achievement of the goals Millennium Development Goals (MGDs) mostly in regard to maternal health. These include goals like poverty reduction, child survival and women empowerment among others. In addition, the formulation and the eventual implementation of free maternal care by the new Kenyan government which took office on March, 2013 is bound to have extensive impacts in reducing MMR among Kenyan women despite some inherent challenges which might confront this program. These are just some of the programs which have been primed by the Kenyan government towards ensuring reduction of MMR and increasing the access of maternal health among Kenyan women. Recommendations In regard to the new programs, it is recommended in this paper that the government through the Ministry of Health ought to invite input from diverse stakeholders in the health sector, for instance, the doctors, nurses and private health facilities’ owners. This will be core in ensuring precise identification and address of the inherent challenges to maternal health in the country. Additionally, this will ensure collaboration and cooperation among these stakeholders in the implementation of the set policies. Secondly, the government ought to commit increased investments in the expansion of the current health facilities which offer maternal services, recruitment of more healthcare personnel and equipping these health facilities. This is key in addressing diverse challenges which might arise out of the influx of women mostly seeking to take advantage of free maternal health. This is based on the backdrop of the fact that despite there being many health facilities in the country, a study on maternal mortality in Kenyan hospitals by Magadi et. al., (cited by Ziraba et. al., 1) revealed that only Pumwani Hospital which is the specialist obstetric hospital in Nairobi had better equipment compared to other hospitals and thus recorded lower maternal mortality rates when juxtaposed with these other hospitals both within and outside Nairobi. Additionally, based on the nomadic economic set-up of some of the communities in Kenya, it is recommended that mobile maternity facilities ought to be established among these communities. The gravity of MMR among the nomadic and pastoral communities is evidenced by Mace and Sear (cited by Sheik-Mohamed and Velema, 697) who estimated that the maternal mortality rates among the Gabbra pastoralists in Kenya stands at 599 per 100,000 births which is an extremely high figure. Thus, the implementation of the mobile maternal health facilities will be central in addressing the maternal health issues among these nomadic and pastoral communities as they seek to embrace the benefits of the free maternity program rolled out by the new government. Cost implications The achievement of the above recommendations has several cost implications. This is best epitomized whereby there is a necessity of increased budgetary allocation by the government towards the expansion of the current healthcare facilities and recruiting more healthcare personnel. Additionally, the procurement of more equipment to furnish other hospitals which have been revealed to be under-equipped also necessitates increased investments, mostly by the county governments under the new devolved system of governance in Kenya. Lastly, the implementation of the mobile maternal health facilities among the nomadic communities will necessitate increased commitment of the local policymakers, collaboration of other agencies working in these communities, for instance, Oxfam as well as elevated government investment in the establishment of these mobile facilities. Conclusion The preceding analysis has explored the background of maternal health in Sub-Saharan Africa. It has also analyzed the nature of maternal health in Kenya in terms of problem in the target group like rural and urban poor and pregnant teenagers, the vulnerability and consequences as well as the implemented programs. Additionally, this paper has forwarded several recommendations to address the maternal health issue in Kenya and lastly explored the cost-implications. Works cited Birungi, Harriet. Maternal Health Care Utilization among HIV-Positive Female Adolescents in Kenya. International Perspectives on Sexual and Reproductive Health, 37.3 (2011): 143-149. Filippi, Véronique, et. al. Maternal health in poor countries: the broader context and a call for action. Lancet, 368 (2006): 1535–41 Finlayson, Kenneth and Downe, Soo. Why Do Women Not Use Antenatal Services in Low- and Middle-Income Countries? A Meta-Synthesis of Qualitative Studies. PLoS Med, 10.1 (2013): 1-12. Izugbara, Chimaraoke and Ngilangwa, David. Women, poverty and adverse maternal outcomes in Nairobi, Kenya. BMC Women's Health, 10.33 (2010). (http://www.biomedcentral.com/1472-6874/10/33). Magadi, Monica. Maternal and Child Health among the Urban Poor in Nairobi, Kenya. African Population Studies Supplement B, 19 (2003): 171-190. Ochako, Rhoune et. al. Utilization of maternal health services among young women in Kenya: Insights from the Kenya Demographic and Health Survey, 2003. BMC Pregnancy and Childbirth, 11. 1 (2011). (http://www.biomedcentral.com/1471-2393/11/1). Owino, Benter. The use of Maternal Health Care Services: Socio-economic and demographic factors—Nyanza, Kenya. IFRA, 21 (1998): 81-122. Pell, Christopher, et. al. Factors Affecting Antenatal Care Attendance: Results from Qualitative Studies in Ghana, Kenya and Malawi. PLoS ONE, 8.1 (2013): 1-11. Sheik-Mohamed, Abdikarim and Velema, Johan. Where health care has no access: the nomadic populations of sub-Saharan Africa. Tropical Medicine and International Health, 4.10 (1999): 695–707 Tomedi, Angelo. et. al. A strategy to increase the number of deliveries with skilled birth attendants in Kenya. International Journal of Gynecology and Obstetrics, 120 (2013): 152–155. Ziraba, Abdhalah, et. al. The state of emergency obstetric care services in Nairobi informal settlements and environs: Results from a maternity health facility survey. BMC Health Services Research, 9. 46 (2009). (http://www.biomedcentral.com/1472-6963/9/46). Read More