As one of our ‘signature programmes’ approaches the end of its first cycle, I travelled to Kenya to look at how better accessibility and services have led to improved maternal and neonatal health.
Western Kenya is fertile, yet most people live in poverty. Only 20% of households have hand washing facilities, less than 55% of children are registered at birth, and less than 10% of women complete secondary education. The under-5 mortality rate is among the highest in the country – at 82 deaths per 1,000 children born.
The terrain is unforgiving – mountainous, unlit and unpaved roads, many of which are impossible to travel by car and hard to navigate even for motorbikes, particularly in rainy conditions. The security situation is volatile, with regular outbreaks of tension and violence. While a number of small dispensaries (with 1 or 2 health workers) operate during the day, at night most are closed and women would have to travel 15km or more in tough conditions.
Get me to the clinic!
To help pregnant women get to health facilities for their check-ups and when they go into labour, we needed to develop a system where trust and safety take priority, and which allow and encourage access to health facilities that offer improved services.
The answer? Recruiting a team of local ‘boda boda’ – or motorbike – drivers onto the project to bring pregnant women to health facilities.
The ‘boda boda’ drivers were selected through community consultation. Drivers need to own their motorbike, to be available round the clock, and to be insured. The community came together to select one driver in each village, so that the relationship with the drivers was built on a sense of community ownership and trust.
Birth prepping and planning
In this setting, making sure pregnant women have appropriate antenatal care and that they can give birth safely is not only a logistical challenge. Local practice was to deliver a baby at home with a traditional birth attendant.
So while the process of selecting drivers was going on, our programme team worked with the community and stakeholders to close the cycle and ensure quality, awareness and access. Traditional birth attendants were retrained to act as birth companions who could go with the mother to the health facility when she was ready to deliver. Community health workers raised awareness of the importance of antenatal visits and safe birth. Men’s local committees (barazas) were approached with messages of awareness of the importance of planning an health around pregnancy. And health facility staff trained mothers in danger signs to look out for and showed them how to make a pregnancy and birth plan.
The results of this concerted effort are striking.
“Before the boda boda drivers, we had 30 mothers delivering in the facility every month. Now we have 60 every month… everyone has the number of the boda boda driver, so they can call him and come to the facility.”
Nurse in Charge, Siboti Health Centre
Women can use the boda boda service both for the first and final (fourth) antenatal visits, as well as when they go into labour. Having been given the boda boda driver’s number in their sessions with the community health worker, the woman can contact him directly or through her birth companion.
Around two thirds of women in labour attend the facility with a birth companion, who can also assist if there are complications on the sometimes long or difficult journey to the facility. When they arrive, the nurse in charge at the health facility or hospital registers the woman and approves the boda boda driver’s journey.
As the project winds down, communities are developing approaches to maintain the service. Save the Children currently reimburses the boda boda drivers for each trip made for an antenatal visit and for a birth. The communities are now discussing ways in which they can come together to pool resources – paying small monthly amounts into a community fund, which can then support the boda boda drivers (for their time and fuel) – or each family setting aside some money to pay for health facility visits.
Pregnancy should not be life threatening. The responsibility to take action and improve access to basic services for pregnant women is a communal one. It needs women’s voices to be heard, and communities’ resources to be invested in women’s and babies’ health.