Improving the demand and health services for pregnant women and newborns in underserved communities
Supporting SDG 3: towards universal coverage
The Micronutrient Initiative (MI) is focused on improving nutrition for the world’s most vulnerable, especially women and girls.
From 2011 to 2015, as part of our efforts to improve women’s nutrition, MI worked with communities in Kakamega, in collaboration with national governments and partners, to increase access to antenatal care (ANC), birth care and postnatal care (PNC) for pregnant women and their newborns. This community-based approach included increasing access to essential healthcare services, medicines and other commodities, such as vitamins and minerals.
The lessons learned from the project in Kakamega, Kenya could be adopted in other communities faced with similar challenges for pregnant women and their newborns.
The challenge in Kakamega, Kenya
Less than half of pregnant women in Kenya have the World Health Organization recommended four ANC visits to receive vaccines, medical care and other essential health and nutrition monitoring.
Notably, only 20% receive any care during the first trimester of pregnancy.
Pregnancy and childbirth can be a difficult time for women and newborns in Kakamega Country, Kenya, which has high maternal mortality rates and some of the lowest rates of delivery with skilled birth attendants and at a facility.
The quality of antenatal services varies widely, and over half of deliveries still occur outside of health facilities without a skilled attendant.
The approach taken in Kenya was to build a community-based health model to increase the uptake of antenatal, birth and postnatal care services for pregnant women and improve the quality of care provided at the facility level.
With a focus to strengthen the link between the community and the health facilities, the approach also aimed to improve the connection between traditional birth attendants (TBAs) with local health facilities and thus support safer and healthier pregnancies to reduce maternal and newborn morbidity and mortality.
Learn more about the project in Kakamega.
The project strategy in Kakamega involved engaging traditional birth attendants (TBAs) and facility professionals to create a stronger link between community and facility, with the ultimate goal of improving the health, nutrition and birth experience of pregnant women.
TBAs play an important role in the community, providing care and support for pregnant women. In 2014, 19% of all births in Kenya were assisted by TBAs; in Kakamega County, that number was close to double the national average, with 30.1% of all births taking place with a TBA by the mother’s side.
Despite their well-respected role in the community, there has long been a separation between TBAs and Kenya’s formal health system. The project partners wanted to find a way that TBAs could work with the local health teams to encourage healthy pregnancies and safe deliveries, while honouring the role of TBAs as a trusted community resources.
Birth Companions and health facility staff now work better together, creating a stronger link between the community and facility health centres. More women have access to obstetric care from a trained health professional during birth, crucial for reducing maternal and neonatal mortality.
By empowering TBAs – through new training to a new role as Birth Companions – they now work with local health teams and encourage healthy pregnancies and safe deliveries, while still being honoured as trusted community resources. More than 90% of active TBAs reported they were “very willing” to become skilled Birth Companions to improve the health of pregnant women and their newborns.
The government has adopted the project model to convert former TBAs into Birth Companions. In addition, the Kakamega County Government is continuing the community personnel incentives.
Key highlights of the project results include:
- 73,766 pregnant women & newborns reached.
- 4,000 community & facility health personnel trained.
- 230 service providers received simulation and team-work training and Emergency Neonatal & Obstetric Care curriculum.
- 39 new community health units were established and 26 were strengthened, to ensure that pregnant women had access to needed healthcare. In addition, all are now linked formally to the healthcare system.
- More than 19,000 people participated in “dialogue days” to improve health in their community.
- 23 father-to-father groups (273 members) and 69 mother-to-mother groups (1,023 members) were developed to support health/nutrition discussions.
- 345 TBAs were converted to Birth Companions. They registered and received incentives for referring over 11,000 women to health facilities.
- A community-based health information system was established and is readily available online to store, synthesis & use data.
We worked with the following partners to address the challenge of how to effectively deliver, prove update of and monitor maternal and newborn health services at the community level for severely under-served areas:
- Kenyan Ministry of Health
- Amref Health Africa, Kenya
- University of Washington, PRONTO, USA
- University of Nairobi, Kenya