Kenya’s President Mwai Kibaki Has the Opportunity to Advance the Realization of Millennium Development Goal 5 by Kenya Shillings 1.5 Billion to Improve Maternal Health During This Financial Year.

Kenya’s President Mwai Kibaki has the opportunity to advance the realization of Millennium Development Goal 5 by Kenya Shillings 1.5 Billion to improve maternal health during this financial year.

President Mwai Kibaki speaking in Rwanda said that Kenya has committed considerable resources and put in place the necessary institutional and policy frameworks in an endeavor to ensure the realization of the Millennium Development Goals.

With regard to poverty, President Kibaki noted that despite the registered decline in absolute poverty levels there were fears that many African and South-Asian countries may be unable to accomplish the MDGs.

“Despite these achievements there is a realization that a large number of African and South-Asian countries may be unable to attain the MDG’s targets set by 2015, especially in relation to elimination of extreme poverty. In addition, the reduction of child mortality rates and improvement of maternal health are still matters of great concern,” said President Kibaki.

The President told the meeting that Kenya was committed to meeting the Millennium Development Goals.

We want to see if indeed Mwai Kibaki is a man of his word. He has a fantastic real time opportunity to demonstrate to Kenyans and especially the women of Kenya that he cares for Maternal Health.

How?

Well, Women under the banner of the Partnership for Change and World March of Women Kenya Chapter presented a petition to the National Assembly ON 18TH AND 19TH August this year urging Parliament to vote more money for the improvement of maternal health.  The President knows about this petition as, despite Police marshalling our Petition March, his official motorcade had a near mishap when it drove speeding through the large procession of women waiting to present their public petition outside Parliament’s gates.

Now, lady luck smiles at the women of Kenya who might just forgive the President for causing a near shock delivery in the aftermath of his speeding Presidential cavalcade.

Four women members of Parliament accepted our petition and promised to act on it. And they did. They found Kshs 1.5 billion that can be allocated for Maternal health in this financial year 2010/2011.

There is money in the budget of the Ministry of Public Health and Sanitation that appears to have no explicable allocation.  The Ministry received Ksh 1.5 billion more than it requested from Treasury and the women of Kenya think this is money which should be spent on improving maternal health care this year.

The Hansard of Parliament records that the Chairman of the Parliamentary Health Committee revealed the existence of the Ksh 1.5 Billion in the ministry of public health and Sanitation that can be allocated towards Maternal health and MDG 5.  Indeed Dr. Monda, M.P., said “We, as a Committee, shall be putting our eyes on the Ministry to see that the extra funds of Kshs1.5 billion are used to offer services that will benefit the population of this country.”

Will Mwai Kibaki direct his Minister to use this extra money to support women and honour his commitments and those of the Government of Kenya to the women of Kenya?

EXTRACT FROM THE PARLIAMENT OF KENYA HANSARD AUGUST 18TH 2010

NATIONAL ASSEMBLY

OFFICIAL REPORT

Wednesday, 18th August, 2010

The House met at 2.30 p.m.

[Mr. Deputy Speaker in the Chair]

Page 46 Wednesday, 18th August, 2010(P)

Vote 49 – Ministry of Public Health and Sanitation

Mrs. Odhiambo-Mabona: Mr. Temporary Deputy Speaker, Sir, thank you for giving me this opportunity to support Vote 49. In supporting, I want to note that the Ministry has been allocated an extra Kshs1.5 billion that they did not ask for.

I would want to urge the Minister that in light of the fact that I will be receiving a petition from World March of Women, Kenyan Chapter and Partnership for Change tomorrow, on behalf of the Parliamentary Caucus on Children on the issue of maternal and infant mortality rates in Kenya, please, allocate the entire Kshs1.5 billion to be utilised for reducing maternal and infant mortality rate in Kenya.

Mr. Temporary Deputy Speaker, Sir, I am saying so because even though you have given us those figures, if you compare them with worldwide figures, Kenyan standards are unacceptably high. If you look at women and girls who die due to pregnancy related complications, it is 14,700 and 294,000 to 441,000 who suffer from disabilities that are caused by complications during pregnancies and child birth such as obstetric fistula.

I would also want to encourage the Minister that with the new Constitution, there are two important issues that relate to the issues I would like us to look at. One is the issue of equity, especially for rural areas. Many of the women who die, do so in rural areas. There is also regional equity. Areas like Nyanza which lead in child mortality rates because they cannot access health centres, must be given priority under the new Constitution. Article 26 of the new Constitution was demonized. Please, give light to it by protecting the lives of women and children. Coming up with the demonized Reproductive Health Bill does not talk about abortion; it talks about preventing the lives of women and children.

With those few remarks, I beg to support.

—–

Read the entire Hansard of this debate from page 35 here:

related: IMPROVE MATERNAL HEALTH: IS ACHIEVING MILLENNIUM DEVELOPMENT GOAL FIVE (MDG 5) ELUDING KENYA?

Press Release: World March of Women Kenya Chapter to Present on Thurday 19th August 2010 a Petition for Action to Kenya Parliament on Millennium Development Goal 5 to Improve Maternal Health and Prevent Deaths of Mothers and Children from Preventable Diseases

PRESS RELEASE

MILLENNIUM DEVELOPMENT GOAL 5 : IMPROVE MATERNAL HEALTH IN KENYA.

ACTION BY PETITIONING PARLIAMENT TO INCREASE THE BUDGET ALLOCATION TO MATERNAL HEALTH CARE & PREVENTION OF DEATHS OF KENYAN MOTHERS AND CHILDREN FROM PREVENTABLE DISEASES.

We the world March of women Kenyan chapter;

Undertaking the role of motherhood with pride that it disserves,;

Honouring our mother country with our God given productive role

Acknowledging that;

  • Kenya has just passed a new constitution that recognises reproduction health as a basic right for every Kenyan,
  • That Kenya is a signatory to the 5th millennium goal ‘to improve maternal health’
  • Kenya pledged to increase health sector allocations by upto 15% of government expenditure in Abuja and reconfirmed its commitment at the AU summit in Kampala in July 2010
  • Kenya committed itself to invest more in community health workers

Respecting the fact that even though complication of pregnancy cannot always be prevented, deaths can be averted if women receive proper medical care

Recognising that the government is the custodian of our consolidated fund and parliament is responsible for proper budgetary allocations

Believing that the women of Kenya are the backbone of this nation call upon;

  • Kenyan government to honour its pledge to the women of Kenya.
  • Parliament to increase allocations to the health sector and more specifically to maternal health care and preventable diseases.
  • Parliament to establish a select committee to look into maternal and child deaths.
  • Parliament to identify funds within the National budget which can be re-allocated to immediate needs for maternal health.
  • Parliament to celebrate international women’s day and international Children’s day as official parliamentary occasions in solidarity with all women and children of Kenya.

Tomorrow, Thursday, 19th August 2010, World march of Women Kenya Chapter together with our partners and networks will commence action towards advocating for improved maternal health and prevention of deaths of Kenyan women and children from preventable diseases.

We will present the petition to parliament at 10.00 a.m on thursday 19th August 2010 and thereafter announce the launch of our online international campaign to collect ten million signatures worldwide in solidarity with all the countries that are committed to achieving millennium development goal No.5

Issued on Wednesday, August 18, 2010 at Nairobi Kenya, by the

World March of Women – Kenya Coordinating Body

1.       Anne Ngatia

2.       Lydiah Dola

3.       Anne Apiyo

4.       Beatrice Kamau

5.       Jayne Mati

6.       Deborah Kayalo Sagasi

7.       Ruth Vulimu Limo

8.       Jackline Wangare

9.       Damaris  Toboso

10.     Florence Keya

11.     Betty Sang

12.     Tafle Omar

13.     Jane Onyango

14.     Mumbi Njau

15.    Sophie D. Ogutu

Download full press statement

PUBLIC PETITION

Pursuant to Standing Order 205 (2)

SUBJECT MATTER: BUDGETARY ALLOCATION FOR MATERNAL HEALTH CARE AND FOR PREVENTING DEATHS OF KENYAN MOTHERS AND CHILDREN FROM PREVENTABLE DISEASES

To The National Assembly of Kenya

We, the undersigned

Petitioners are Citizens of the Republic of Kenya and wish to

Draw the attention of the House to the following:

In 2001, Kenya along with other African countries pledged at Abuja to increase allocation to the health sector up to 15% of government expenditure.

This pledge was repeated again in the recently concluded African Union Summit in Kampala, 19 to 27 July 2010;

African leaders including Kenyan have pledged to invest more in community health workers and re-committed to meeting the Abuja target. In the meantime, national budget allocations to health remain far below this target.

The Kenya budget for the fiscal year 2010-11 allocated slightly over Kenya shillings 55 billion to both ministries of Medical Services and Public Health and Sanitation. This is approximately 5.5 percent of the total Government of Kenya expenditure. About 41 percent of this allocation went to the Ministry of Public Health and Sanitation, which is responsible for primary health care including maternal health care up to Level 3 (health centre). Considering that this allocation translates to about 2.3 percent of total GOK expenditure, it is apparent that extremely little will be available for maternal health services.

In our view, this level of investment (about 2.3 percent of total GOK expenditure allocated to primary health care) does not reflect a strong government commitment to achieving MDG5 by 2015; it does not demonstrate high prioritization of maternal and newborn death prevention and reduction among the national priorities.

Further, 480 children die every day from preventable disease

THEREFORE your humble petitioners PRAY that Parliament

1. Resolve to urge the Government to fulfil its commitment to increase allocation to the health sector up to 15% of government expenditure within the current Financial Year, In addition, the Government should ensure more funds are channeled to maternal health services.

2. Resolve to establish a select Committee to look into Maternal and child deaths and working with experts to identify funds within the National Budget which can be reallocated to meet the target commitment.

3. Resolve to celebrate International Women’s Day and International Children’s Day as official parliamentary occasions in solidarity with all women and Children of Kenya

And your PETITIONERS will ever pray

Name of Petitioner

Address

National

ID/Passport

Signature/Thumb

Impression

1.

2.

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4.

5.

6.

7.

8.

9.

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Download AU Decisions, Declarations and Resolution on 27 July 2010, Kampala Uganda

Improve Maternal Health: is Achieving Millennium Development Goal Five (mdg 5) Eluding Kenya?

IMPROVE MATERNAL HEALTH: IS ACHIEVING MILLENNIUM DEVELOPMENT GOAL FIVE (MDG 5) ELUDING KENYA?

 

Professor J K G Mati MD

 

Introduction

The purpose of this discussion paper is first and foremost to keep the torch burning on the unacceptably high rates of maternal deaths that persist in Kenya. It reviews where we are with regard to attainment of Millennium Development Goal 5 (MDG5), and examines some of the critical barriers to good progress in improving maternal health in Kenya. The views expressed in the paper are founded on respect for women’s constitutional right to life and health, and therefore their right to quality reproductive health services, which ensure that every pregnancy is wanted; all pregnant women and their infants have access to skilled care; and that every woman is able to reach a functioning health facility to obtain appropriate care in the event of complications. Going through pregnancy and childbirth safely is what every woman should expect. We know that even though complications of pregnancy cannot always be prevented , deaths from these complications can be averted. Up to 75 percent of all maternal deaths can be averted if women received timely and appropriate medical care. We have the knowledge of the causes of these deaths and how they can be prevented; we know what works and what does not work. It is now generally accepted that lack of skilled assistance during childbirth is the most important determinant of maternal mortality. What, in my view, is lacking is the commitment, at all levels, to act; to make the reduction of maternal mortality a high priority; and to reflect this in resource allocations to health services, especially for reproductive health care.

 

Background

On July 15, 2010 the Honourable Member of Parliament for Laisamis asked the Minister of Public Health and Sanitation (a) to provide the current statistics of maternal deaths in the country (Kenya) and (to) state the steps the Government has taken towards achieving MDG5; and, (b) what achievements the Government has made so far in terms of improving maternal health. I would like to believe this was not just a coincidence, and that it had a bearing on the forthcoming Africa Union Summit in Kampala, Uganda, July 19-27, and UN High-level Plenary Meeting on the Millennium Development Goals (MDG Summit) scheduled to take place in New York, September 20-22, 2010, both with an objective of reviewing progress towards the attainment of MDGs by 2015.

 

In his reply the Honourable Assistant Minister of Public Health and Sanitation relied heavily on the findings in the Kenya Demographic Health Survey (KDHS) of 2008/9 which gave a maternal mortality ratio of 488 per 100,000 live births. He emphasised there were wide regional disparities, and that in some provinces the mortality ratio rises up to 1,000 per 100,000 live births. This translates to approximately 8,000 pregnant Kenyan women dying each year from pregnancy-related complications. Among the steps being taken by the Ministry is the development of a National Road map for acceleration of reduction of maternal and newborn morbidity and mortality which outlines the strategies, priority actions and broad activities for acceleration of attainment of MDGs 4 and 5. The Government through the Economic Stimulus Programme (ESP) intends to expand pre- and in-service training of health workers and to employ and deployed 20 nurses in each constituency. In addition, model health centres are to be built in 200 constituencies, and 300 ambulances purchased and distributed to all health centres in the country.

 

Review of the progress made in improving maternal health in Kenya

Unfortunately, the Minister was not specific regarding the progress the Government has made so far in terms of achieving MDG5 of improving maternal health in Kenya. Fortunately, in this country we have serially compiled data which can be used to show trends in the attainment of the various indicators of improved maternal health. These are briefly reviewed below.

 

The targets for MDG5 (Improve maternal health) are two: 5.A: Reduce by three quarters between 1990 and 2015, the maternal mortality rate; and 5.B: Achieve, by 2015, universal access to reproductive health. The indicators to show attainment of these targets are as follows: 5A- Maternal Mortality Ratio and Proportion of births attended by skilled health personnel; and 5B- Contraceptive prevalence rate; Adolescent birth rate; Antenatal care coverage; and Unmet need for family planning. Table 1 summarises the progress Kenya has made towards the achievement of these targets.

 

Table 1: Progress made towards achievement of MDG5 in Kenya.

 

Goal 5: IMPROVE MATERNAL HEALTH

TARGET

Indicator

1990a

1995b

2003c

2008/9d

2015e

Target 5.A: Reduce by three quarters between 1990 and 2015, the maternal mortality rate

5.1 Maternal Mortality Ratio (per 100.000 live births).

590

590

414

488

147

 

5.2 Proportion of births attended by skilled health personnel (%)

44

42

40

44

90

 

 

1993

1998

2003

2008/9

2015

Target 5.B: Achieve, by 2015, universal access to reproductive health

 

5.3 Contraceptive prevalence rate (%)

33

 

 

39

 

39

46

70

 

5.4 Adolescent birth rate (%)

 

21

23

18

 

 

5.5 Antenatal care coverage (at least four visits) (%)

 

60

52

47

 

 

5.6 Unmet need for family planning (%)

 

 

25

25

26

 

Sources:

a Baseline MDG NHSSP- II (2005-2010); b Baseline NHSSP-I (2000-2005); c KDHS 2003; d KDHS 2008/9; e MDG 2015

 

Target 5.1 Maternal mortality ratio

According to the KDHS 2008/9 maternal deaths represent about 15 percent of all deaths to women age 15-49 in Kenya. A maternal death was defined as any death that occurred during pregnancy or childbirth or that occurred within two months of the birth or termination of a pregnancy, even if the death was due to non-maternal causes. The maternal mortality ratio (MMR) during the 10-year period before the 2008/9 survey was estimated at 488 per 100,000 live births, which is slightly higher than, but not significantly different from, the figure of 414 per 100,000 live births, which was reported in the 2003 KDHS. This implies that in the period between the two surveys, the rate of maternal deaths had either stagnated more or less at the same level, or had actually increased. Clearly, these figures do not depict a reducing trend towards the target of 147 maternal deaths per 100,000 live births set for 2015.

 

Target 5.2 Proportion of births attended by skilled health personnel

Skilled attendance at delivery is an important variable that influences the birth outcome and the health of the mother and the infant. One of the indicators of skilled attendance is the proportion of births that take place in health facilities. Skilled attendance can also be accessed through domiciliary or community midwifery. Proper medical attention and infection prevention practices during delivery can reduce the risks of obstetric complications that increase the risk of morbidity and mortality for the mother and her baby.

 

The KDHS 2008/9 showed that only about 43 percent of births in Kenya took place in a health facility, and that the decision on place of delivery was mainly influenced by factors related to ease of access- availability of transport to, and charges for services at, the health facility. The same survey also reported that, overall, only 44 percent of births in Kenya were delivered under the supervision of a skilled health provider (nurse, midwife or doctor). Contrary to the prevailing policy, traditional birth attendants (TBAs) assisted up to 28 percent of mothers at delivery (the same percentage as were assisted by nurses and midwives!).

 

In terms of progress made, the proportion of births assisted by medically trained personnel has increased only marginally, from 42 percent in the 2003 survey to 44 percent in 2008-09, this being far below the projected target of 90% for 2015. The proportion of mothers that received skilled attendance was, as would be expected, lowest in rural areas, and among women of lowest socio-economic status.

 

Target 5.3 Contraceptive prevalence rates

Kenya’s Family Planning Programme was established in 1967, a pioneering step in sub-Saharan Africa, which saw the contraceptive prevalence rate among married women (CPR) rise from 7 percent in 1979 to 17 percent in 1984, 27 percent in 1989, and 33 percent in 1993. However, during the period 1998-2003, CPR leveled off at 39 percent with wide regional as well as social strata differentials. The KDHS 2008/9 has demonstrated a rising trend, with CPR reaching 46 percent for use of any method and 39 percent for use of modern methods of family planning. While this trend is encouraging, CPR still falls short of the target for 2015 (of 70%), by more than 20 percentage points.

 

Target 5.4: Adolescent birth rate

Besides being an important contributor to the overall population growth, adolescent fertility is a determinant of maternal mortality rate, as well. Complications of pregnancy and childbirth are the leading causes of mortality among women between the ages of 15 and 19 , this to a large extent results from the lack of access to good-quality health care, including antenatal care and skilled attendance at delivery. The World Health Organization estimates show that the risk of maternal death is twice as great for women between 15 and 19 years when compared with those between the ages of 20 and 24 years . In Kenya, the 2008/9 KDHS showed that there had been a reduction in the proportion of teenagers who had begun childbearing (adolescent fertility), down to18 percent from the figure of 23 percent reported in the 2003 KDHS, although wide regional disparities persisted. Further analysis showed that the proportion of teenage mothers had declined from 19 percent in 2003 to 15 percent in 2008-09, while the proportion of those pregnant with their first child had declined from 5 percent in 2003 to 3 percent in 2008-09. These are encouraging results, even though it is difficult to explain the apparent reduction in adolescent fertility at a time when there was a fall in CPR (any method), among women 15-19 years, between the two surveys (from 6.7 percent in 2003 to 5.9 percent in 2008/9). Is this an impact of the “NimeChill” campaign?

  

For comparison, the teenage birth rates in South Africa and Nigeria are 7 and 10 respectively.

 

Target 5.5: Antenatal care coverage

Antenatal care is a critical intervention for the promotion of maternal and child health. The goal of antenatal care is to main tain and improve the health of the woman and her baby in utero, so that both are brought to labour in a good state of health. Antenatal care aims to diagnose and treat abnormalities of pregnancy soon after their symptoms are apparent; and to screen women for other conditions which may be present, before their symptoms manifest . Although the majority of pregnant women in Kenya attend an antenatal clinic at least once, usually starting in the second trimester, the KDHS 2008/9 showed that only 47 percent made the minimum four visits, with only 15 percent doing so in the first trimester as recommended by the World Health Organisation.

 

Target 5.6: Unmet need for family planning

Unmet need for family planning reflects the desire among Kenyans to control their fertility. Usually, it is the proportion of married women who either want no more children or wish to delay their next birth by at least two years, and are not using a family planning method. The KDHS 2008/9 showed that there is widespread desire among Kenyans to control the timing and number of births they have (i.e. to plan their families). Almost 54 percent of all currently married women either did not want to have another child or had already been sterilized, while nearly 27 percent would like to wait two years or longer before their next birth. Interestingly, the proportions were similar among currently married men, although men tended to be slightly more pro-natalist than women. Overall, there have been only minimal changes in fertility preferences among married women since 2003. Kenyan women continue to experience a high unmet need for family planning, with roughly one-quarter of currently married women in the three consecutive KDHS surveys since 1998 indicating that they have unmet need for family planning. Levels of unmet need are influenced by socioeconomic status of the woman; unmet need declines steadily with increase in the level of education and wealth status.

 

This may answer the Hon Member for Laisamis?

Having reviewed the status of the indicators for MDG5, we can now attempt to answer the tail end of the question asked to the Minister of Public Health and Sanitation, i.e. what achievements the Government has made so far in terms of improving maternal health. From the above data, it can be said that whereas considerable effort has been put to health policy and strategic planning, including the development of reproductive health policy, reproductive health strategy and the road map for accelerating the attainment of the MDGs related to maternal and newborn health in Kenya, these are yet to translate to actual reduction in maternal deaths. In terms of Target 5A, Kenya has not started showing any downward trend in MMR, or an increase in the proportion of births attended by skilled health personnel. However, in the case of Target 5B, the apparent recent rising trend in CPR, if it can be sustained, may get us close to the figure projected for 2015. Otherwise, a lot more effort is needed to produce any meaningful gains as far as the other indicators are concerned.

 

Kenya can benefit from lessons learned at home and abroad

1. Efforts to reduce maternal deaths have for decades been a focal point of international agreements and a priority for women’s rights and health groups throughout the world; these include the Alma Ata Declaration (1978), the International Conference on Population and Development (1994), the Beijing World Conference on Women (1995), and the Millennium Development Goals (2000). Ten years on from the original adoption of the MDGs at the Millennium Summit of 2000, and despite remarkable progress in some countries, many others are falling short in their achievement, and this is where Kenya falls. If the MDGs are to be achieved by 2015, not only must the level of financial investment be increased (see below) but innovative programmes and policies aimed at overall development and economic and social transformation must be rapidly scaled up and replicated.

2. It is generally agreed that Millennium Development Goals are inter-related; consequently, achievement of MDG5 is closely tied to the progress made in several other goals, especially Goal 1: Eradicate extreme poverty and hunger; Goal 2: Achieve universal primary education; Goal 3: Promote gender equality and empower women; and Goal 6: Combat HIV/AIDS, malaria and other diseases. There is accummulating evidence that the impacts of the AIDS epidemic are a strong counter force to efforts to lower maternal mortality in sub-Saharan Africa. High rates of HIV infection and AIDS-related illness among pregnant women will continue to contribute to higher rates of maternal mortality, unless current AIDS prevention and treatment programmes can be sustained and expanded.

 

3. From available evidence and experiences on the ground, it is obvious that accelerating progress on achievement of MDG5 requires not only a strengthened, but a radically transformed health system. Provision of reproductive health services (including maternal health care) cannot be considered in isolation, and generally, these services are strong where the health sector is strong, and vice versa. According to the World Health Organisation a health system comprises all structures, institutions and resources that are devoted to producing actions whose primary intent is to improve health. Service provision is one of the essential functions of a health system, and effective service provision can only take place where there is adequate infrastructure and qualified human and material resources, which in turn require adequate financial allocation and sound management. In order to accelerate progress on achieving MDG5, emphasis ought to be on sustainable high impact interventions, which should incorporate strengthening community partnerships and initiatives that aim to empower women. These high impact interventions include access to skilled attendance at delivery; emergency obstetric and post abortion care; functional referral systems; and a functional interface between the community and health facilities. Countrywide expansion of health outlets staffed by adequately trained health service providers is critical to effective implementation of these interventions. Employment of 20 nurses per constituency as planned under ESP is not enough, and is certainly not an equitable way of addressing the current shortage of health workers in Kenya. Calculation of health workers that are needed should be based on factors such as population size and its spatial distribution.

 

4. A recent study has identified what the authors call “powerful drivers of maternal mortality reduction”; these are as follows:

(a) Fertility decline as reflected by falling total fertility rates (TFR): Family planning as an instrument for birth control is at the same time a primary intervention for the prevention of maternal mortality. Family planning can also prevent high risk pregnancies which contribute to maternal and perinatal deaths. As a result universal access to reproductive health is one of the targets of MDG5, and CPR and unmet need of family planning are among the indicators for this target.

 

(b) Economic growth as reflected in increased per capita income: The economic factor can operate at the individual household or national levels. There is no doubt that rates of maternal death are highest within the poorer populations, which face several barriers to accessing health care services. At the same time inadequate resources is a major constraint to expansion of health services and improvement of quality of the services provided.

 

(c ) Empowerment of women as reflected in educational rates among women: Education of a woman is a powerful driver of better health and well being of the family, including empowerment to take decisions regarding seeking healthcare for herself and her family. 

 

(d) Improved obstetric care as reflected in access to a skilled attendant at delivery: Skilled attendance at delivery is a key determinant of maternal mortality, and a reflection of a functional health care system. In order to ensure access to skilled attendance the government must increase investments in basic health care, infrastructure, training and deployment of qualified health workers; paying special attention to equity in access to obstetric services. Every woman should be assured of access to skilled care throughout the continuum of pregnancy, childbirth and postnatal periods. 

 

5. To have an impact, interventions must target populations with the most need. A key policy objective stated in the National Health Sector Strategic Plan II (2005-2010) is to increase equitable access to health services for all through addressing equity and by expanding access to basic services with special focus on the community level. Also, Kenya’s Vision 2030 states government’s commitment to reducehealth inequalities and to provide access to those excluded from health care by financial reasons . As reviewed above, most reproductive health indicators portray big disparities between the poor and the better off with respect to access to health care services and health status. Generally, the poor lack access to health care in terms of availability, affordability, and acceptability. Hence, for interventions to achieve the intended impact they must target populations with the most need, in most cases these include urban and rural poor, the “hard to reach” groups and people with disabilities. Others ‘hard to reach’ are adolescents and youth, especially those out of school, migrant workers in industries and farms, internally displaced persons and refugees. These ‘marginalised’ sections of the population are frequently under-served by health services, in a large part because of poverty, as well as difficulties in accessing static health institutions, but most importantly, because their peculiar health needs are not adequately addressed in the planning of health services. Hopefully this may change under devolved governments in the near future?

6. Need for improved and sustained health financing. Inadequate funding and inequitable prioritization of needs are among the most important factors that are slowing the pace of achieving MDG5 in most African countries, including Kenya. Health financing that does not prioritize the ‘marginalized’ populations ends up benefiting mainly those (wealthier) groups that are at lower risk of maternal mortality. These in most cases, will be in the minority, and as such cannot improve on the national statistic on maternal mortality.

In 2001, Kenya along with other African countries pledged at Abuja to increase allocation to the health sector up to 15% of government expenditure. This was once again repeated in the recently concluded African Union Summit in Kampala, 19 to 27 July 2010; African leaders (including Kenyan), have pledged to invest more in community health workers and re-committed to meeting the Abuja target. In the meantime, national budget allocations to health remain far below this target. The Kenya budget for the fiscal year 2010-11 allocated slightly over Ksh 55 billion to both ministries of Medical Services and Public Health and Sanitation. This is approximately 5.5 percent of the total Government of Kenya expenditure. About 41 percent of this allocation went to the Ministry of Public Health and Sanitation, which is responsible for primary health care including maternal health care up to Level 3 (health centre). In my view, this level of investment (about 2.3 percent of total GOK expenditure) does not reflect a strong government commitment to achieving MDG5 by 2015; it does not demonstrate high prioritization of maternal death prevention and reduction among the national priorities.

 

Conclusions

From the data reviwed in this paper it is obvious that a lot remains to be done in Kenya if we are to get anywhere close to attaining the targets set for MDG5. There are areas where some progress has been observed, notably the recent increase in CPR, which, if sustained, may just make it close to target.  Otherwise the progress has been inadequate in almost all other indicators.  As stated above, we have the knowledge of the causes of maternal deaths, and how they can be prevented. We know what interventions work and which do not; what appears to be the main barrier is the lack of commitment to act; to prioritize reduction of maternal mortality, and to reflect this in resource allocations to the health sector, and to maternal health, in particular. From available evidence it is obvious that MDG5 cannot be achieved without emphasis on equitable expansion of access to basic services for all. Finally, let me end with remarks oft-attributed to Professor Mahmoud Fathalla of Egypt , "Women are not dying because of diseases we cannot treat. They are dying because societies have yet to make the decision that their (women’s) lives are worth saving." When will Kenya decide?

 

ENDNOTES

In at least 15% of pregnant women serious obstetric complication can occur that usually cannot be predicted or prevented in advance.

 

A skilled attendant as defined by the WHO, ICM and FIGO is “a health professional – such as a midwife, doctor, clinical officer or nurse- who has been educated and trained to proficiency in the skills needed to manage normal (uncomplicated) pregnancies, childbirth and the immediate postnatal period, and in the identification , management and referral of complications in women and newborns” (The Critical Role of the Skilled Attendant: a joint statement by WHO, ICM and FIGO. Geneva, World Health Organisation, 2004)

 

Proportion of women age 15-19 who were mothers or first time pregnant at the time of survey.

Locoh, Therese. (2000). "Early Marriage And Motherhood In Sub-Saharan Africa." WIN News.’.’ Retrieved July 7, 2006. en.wikipedia.org/wiki/Teenage_pregnancy  

 

 

Pregnant women should routinely receive information on signs of pregnancy complications and be checked for them at all antenatal care visits; this should include testing for HIV. In addition, they should receive prophylactic treatment against anaemia, and malaria where this is endemic, and be encouraged to make plans for the impending birth, including where it will take place and how to get there in case of emergency.

 

www.thelancet.com. Published on line April 12, 2010 DOI:10.1016/S0140-6736(10)60518-1

www.thelancet.com. Published on line April 12, 2010 DOI:10.1016/S0140-6736(10)60518-1

Republic of Kenya: Kenya Vision 2030 Brochure, July – August, 2007

 

Past President of International Federation of Gynaecology and Obstetrics Societies (FIGO)