Jamra primary scholl for children affected by HIV/AIDS, drugs or poverty, Senegal (c) Nell Freeman/Alliance Participants in the Photovioce project, Ecuador © Marcela Nievas for the Alliance
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Community partners in Kenya pull together to stop maternal and child deaths


 Lucy Simiyu, the NPP Kenya Coordinator (c) KANCO

“It’s amazing to see what community based organisations (CBOs) can do. When you sit with CBOs they have all these ideas and strengths and while they lack the capacity, they are still willing to press on,” says Lucy Simiyu, National Partnership Platform (NPP) Coordinator in Kenya.

The NPP is a partnership of 27 organisations that formed in June 2010 and is hosted by KANCO, an Alliance linking organisation. The members work together on issues of common interest. This year, thanks to the support of UK aid, the NPP has focused on improving the lives of pregnant women, particularly those living with HIV, and their newborns.

Each year 40,000 to 50,000 Kenyan infants could be infected with HIV due to mother to child transmission. The UK aid project aims to reduce HIV-related maternal and newborn deaths by improving the number of pregnant women referred to health centres and the number receiving PMTCT and increasing awareness of maternal and newborn health issues.

The project worked in the Nairobi slum areas; Kajiado in the Rift Valley (Kenya’s largest province, which is primarily populated by the Maasai, a pastoralist community), and Western Province, mainly in Kakamega and Busia, which borders Uganda and is a main trucking route.

What are the problems?

NPP organisations work directly with communities and see the challenges women trying to access maternity and HIV services face.

Lucy explains: “Poorer women are at a disadvantage…When it comes to going to hospital and I have 100 shillings I’d rather buy food for my children than take care of myself. I’ll just hope I carry to full term and the baby is healthy. These difficult living conditions create a barrier that stops most women seeking skilled care in hospital.

“Most women indicate the fee charged at health centres is above what they can afford, the irony is it is much cheaper than traditional birth attendants (TBAs) who are favoured by women. Going to hospital means women have to pay in advance a lump sum…With the TBAs they can pay in instalments, although it costs more in the long run.

“Many women say health workers aren’t friendly or polite. They go to TBAs because they take care of them and nurture them. The problem is TBAs aren’t skilled so if a woman starts bleeding they aren’t able to take care of such an emergency, but they are a critical part of the community and we need to look for ways to engage TBAs.

“One of our partners in Kakamega invited TBAs for training on maternal and newborn healthcare. They have since documented a big uptake in … TBAs accompanying women to hospital to deliver. This provides the woman with some comfort and support when she goes to hospital.

“In addition, there’s a lot of ignorance. That’s what we need to change. Even when a woman bleeds they don’t think much about it and hope it will just stop. Unless someone rushes them to hospital or there is a someone who understands what to do, that woman may lose her life and her baby.”

Gender is another critical issue affecting a woman’s ability to get qualified and professional healthcare.

“Men are the decision makers in most of these households,” says Lucy. “In Kajado, in the Masaai community if you are pregnant and start bleeding you have to wait till you have the man’s permission or the money from him to go to hospital…you can’t make that decision as a woman.”

Increasing referrals to health centres

Community health workers in all three areas are referring women to health centres, following training on the issues. The training combined campaigns, edutainment and use of community radio and resulted in 8816 refferals.

Community meetings have reached around 582 people, including pregnant women living with HIV, TBAs, community health workers and village elders.

Raising awareness

To increase awareness at a national level the NPP has trained 59 Key Correspondents (KCs). These are writers from the community who document what is happening at the grassroots level.

“KCs have embraced this project and there’s been a lot of media information on maternal health issues,” says Lucy.

“We have also developed an exciting relationship with Internews who provide training support for the KCs and allow them to use their facilities.”

KCs articles have appeared in Kenya’s mainstream press. Articles are also distributed through keycorrespondents.org and an eforum, which has around 536 subscribers.

Public service announcements have also been developed, and featured between news bulletins on Ghetto 99.9 FM. In Western province, one local FM station invited two speakers to discuss the issues and ensure messages were conveyed in the local dialect.

In Kajiado, partners are working with the Kenya Broadcasting Corporation (KBC) Maasai FM to broadcast messages on the link between maternal and newborn child health and HIV, encouraging the local Maasai community to seek skilled delivery, explaining how to spot delivery danger signs and discussing male involvement in pre and postnatal care.

National advocacy

The NPP developed a national advocacy plan to highlight the user fees issue and push for increased government funding for health. Policy makers have been briefed and meeting with MPs held.

The Hon Dr. Joyce Laboso, MP for Sotik constituency and a member of the Kenya Women Parliamentary Association (KEWOPA), said: “I visited a local health centre and found a cleaner taking on the role of the pharmacist… I was extremely concerned about the situation and raised it with the management who said the pharmacist was on leave... They explained the centre had a shortage of qualified staff.”

Informing and empowering women

Maternal and newborn child health has climbed up the public agenda. More than 26,700 women have been reached with information to help them deliver their babies safely and free from HIV.

Thanks to the determination of the NPP the national campaign to end user fees continues.