Story by Phelgonna Velma,

Grace Karisa, a mother of four, knows first-hand the struggles new mothers and their infants face when accessing quality healthcare. Four years ago she feared the worst when she developed complications just three weeks before her due date. At t hat time, the nearest hospital with a well-equipped maternal services was approximately 60 kilometers away. The journey was long and tideous, with poor road conditions that added to her anxiety. “I was terrified,” Grace recalls. “The journey was long and dangerous, our roads are not so good so it was very bumpy. I feared for my life and that of my unborn child.” She arrived at the hospital just in time for delivery. Her son fought for his life inside the warmth of an incubator, surrounded by the gentle hum of machines and the unwavering presence of his caregivers.

Grace, like many other pregnant women in Kilifi, had faced terrifying experiences due to lack of accessible maternity services for infants. For years, Kilifi’s medical facilities grappled with inadequate equipment and insufficient neonatal care. This dire situation left many infants, particularly those born prematurely or with complications, without the critical care they needed to survive.

Today, she is hopeful as she visits the hospital for antenatal care for the child she is expecting. In recent years, efforts by the county government and local communities have led to the establishment of well-equipped and accessible maternity wings across Kilifi. These units, staffed by dedicated and trained healthcare professionals, are specifically designed to provide intensive medical care to newborns.

Dr Daisy, the medical superintendent, and a general physician in Rabai Subcounty Hospital, has witnessed the transformation brought about by the maternity services in the hospital. “Every baby we save is a victory,” she says. “It’s not just about the medical care; it’s about giving families hope and a future. Our maternity is now equipped with modern incubators, ventilators, and other essential medical equipment.”

According to the Kenya National Bureau of Statistics, infant mortality in Kenya has steadily declined, from 77 deaths per 1,000 live births before 2003 to 32 deaths per 1,000 before 2022 caused by improved health systems like the Maternity Units. In Kilifi County, 85% of births are now attended by skilled healthcare providers, and the majority of mothers receive antenatal and postnatal care.

The availability of Maternity Unit in Rabai Subcounty Hospital, just a few kilometers from Grace’s home, has changed everything. It is well equipped. She can now walk to the dispensary for antenatal care and check-ups, saving time and money. “Thanks to the availability of the maternity unit, I no longer have to spend a lot on transportation. I can now get excellent care by simply walking to the maternity wing,” she heaves a sigh of relief. “Because of this, I’ve been able to save money that I can now use for other things, including my kids’ school fees.”

According to the KDHS 2022 Fact Sheet, 85% of births in Kilifi County are attended by a skilled healthcare provider. Among women aged 15-49 years who have had a live birth, 77% had four or more antenatal visits, 83% received a postnatal check during the first two days after birth, and 90% of births had a postnatal check during the first two days after birth. Additionally, 90% of children aged 12-23 months are fully vaccinated with basic antigens. Neonatal mortality is at 24 deaths per 1,000 births, infant mortality is at 34 deaths per 1,000 live births, and under-5 mortality is at 40 deaths per 1,000 live births.

Source: Kenya Demographic and Health Survey 2022 Fact Sheet

Kenya’s healthcare system is structured hierarchically, from community dispensaries to national hospitals. Community dispensaries, health clinics, sub-county teaching and referral facilities, and national hospitals are designated as levels 1, 2, 3, 4, and 5 under the government’s decentralized system, respectively.

According to the Kenyan Ministry of Health sector strategic and investment plan (KHSSP), two nursing staff are required to serve a population of 10,000 at dispensary levels. At higher levels, a nurse is required for each 10 inpatients, at least two nurses are needed per operating theatre table, and three nurses are required for every 24 hours of eight-hour shifts each. The distribution of healthcare workers within the country is not equitable, resulting in significant health workforce gaps in some counties.

Challenges

Saumu Juma, a nurse at Kombeni Dispensary, highlights the impact of these accessible healthcare facilities. “The number of women attending antenatal clinics has been encouraging,” she says. “This month alone, we’ve had 450 women visit the clinic. The availability of clinical services has greatly benefited the community. Women no longer have to walk long distances for medical assistance.”

However, challenges remain. Many healthcare facilities in the area do not operate round the clock, making it difficult for women to always access care. Nurse Saumu notes that while Rabai Sub-County Hospital, Makatani, and Ribe Hospitals offer 24-hour maternity services, most facilities do not. “If more facilities operated 24 hours, 95% of women would deliver in hospitals,” she says. “The county government of Kilifi is planning to complete Kombeni’s dispensary maternity wing. Once it’s complete, it will possibly operate 24 hours, further reducing the need for home deliveries.

Yasmin, another mother, praises the facility’s services but reiterates the need for 24-hour operations. “The facility offers good services for expectant mothers and their babies, but it only operates during the day, which is unfortunate since one can require medical services at any time,” she says.

Nurse Saumu adds that expectant mothers can help reduce infant mortality by avoiding traditional birth massages, avoiding home deliveries, and keenly observing postnatal care. Attending antenatal clinics in time and delivering in health facilities can reduce maternal mortality through early detection and management of complications.

The ripple effect of the maternity services extends beyond the hospital walls. Community health workers have been trained to identify and refer high-risk pregnancies early, ensuring that mothers receive the care they need before complications arise. Educational programs have also been implemented, teaching parents about the importance of prenatal and postnatal care.

“Before the maternity unit, we were losing babies every day. It was heart-breaking to see mothers leave the hospital empty-handed. Now, with the advanced equipment and specialized care, we are saving lives every single day. It’s a miracle.”

This story was made possible with the support of the UZIMA-DS project, funded by the National Institutes of Health (NIH).