Sub-Saharan Africa is now the epicentre of maternal mortality in the world. Current trends indicate that despite global, regional and national policies to improve Maternal, Newborn and Child Health (MNCH) being in place, countries like Kenya are yet to attain their targets particularly for MDGs 4 and 5 to decrease child and maternal mortality.
Samburu County, falls within the arid and semi arid lands of Kenya. Nearly one third of the population of Samburu County has inadequate access to health, water and education services, as well as livelihood opportunities. The maternal mortality rate is high with 1000/100,000 births; under-five child mortality is approximated at 142/1,000 live births – double the national average. The low health status of women and children is exacerbated by the arid nature of the area coupled with poverty and low literacy levels. Furthermore, cultural beliefs and practices, including female genital mutilation (FGM), early marriages and TBA attended deliveries endanger MNCH in the area.
Children are affected by preventable illnesses such as malaria, diarrhoea and malnutrition. Women have a particularly low social status in pastoralist communities which undermines efforts to improve reproductive health. Harmful cultural practices pose human rights and public health concerns and lead to unacceptable suffering of young girls and women. Low uptake of contraception and cultural norms contribute to early pregnancy affecting maternal health, leading to higher risks of obstructed labour, vesico-vaginal fistulas and foetal death. Samburu experiences low utilisation rates of (reproductive) health services: low use of ANC services (24%); only 15% of births attended by skilled health workers; low levels of child immunisation at 55%. The majority of the health facilities are not equipped to provide emergency obstetric care.
Factors that predispose the Samburu to poor health
- High levels of malnutrition
- Poor access to and utilisation of MNCH services by women and children
- Low literacy levels
- Severely under-resourced health facilities
- Poor infrastructure
- Negative attitudes
- Low engagement and advocacy by civil society organisations
- Inadequate human resources for health
- Absence of functional drug supply chains
- Inefficient referral systems
- Overall weak leadership and governance capacity
- Female Genital Mutilation (FGM) -95% prevalence
- Early marriages for girls result in early sexual debut and in many cases leads to complications during delivery
- Extremely high rate of TBA attended deliveries
- Decision making at family level largely vested in men including on issues of family size, ante natal and post natal care
Overall Objective of the Project
To contribute to poverty reduction in Samburu County, by accelerating the attainment of national targets and MDG 4 (child health) and MDG 5 (maternal health) targets by 2015.
Specific Objectives
- Increase the capacity of community health units and health facilities to provide quality and appropriate MNCH services
- Increase the knowledge and understanding of MNCH rights by youth, women and men
- increase the number of skilled community, health facility workforce and health managers thereby increasing the quality and range of MNCH services
Unique Aspects of the Project
CBHMIS: This project will integrate an Information System and link it to the HMIS (CBHMIS). The Community Based Health Management Information System (CBHMIS) will be designed collaboratively with the HMIS department of the Ministry of Health. Information collected at the community level will ensure that community health information feeds into district information systems. CHWs will collect information at household level and will report this through the local authority hierarchy i.e. to village, sub-location, and finally district level. The information will also be shared with local health facilities and included in their databases. This will enable the community health committees to develop action plans, monitor and evaluate project results and focus interventions to improve MNCH outcomes in the 6 units.
Research and M&E: Emphasis will be placed on testing and evaluating models that are locally appropriate, affordable and applicable. M&E will document evidence of good practices, which will feed into information produced for the action. Issues identified for operational research to be published in reputable journals are: integration of family planning and nutrition, action research on male involvement, lessons learned on minimum incentives, maximum results for CHWs and the development of an approach to effectively address MNCH issues in pastoralist communities.
