Increasing Supply and Demand for Healthcare in Kenya
In a country where one child in 19 dies before their fifth birthday, a typical scenario in Kenya’s western county of Bungoma can be; a mother-to-be is feeling ill; she is not sure whether she should go to hospital, but the husband doesn’t think it’s important, so she stays home. Or the husband is supportive, but the clinic might be too far or too expensive to reach, and if reached, there might not be any available health workers to support her. Or the health workers are there, but they don’t have the knowledge and skills, or the supplies to help her.
For the last three years, Save the Children and GSK have been working on a programme that aims to help reduce maternal and newborn mortality by an ambitious 21% in Bungoma County, by addressing scenarios such as the ones described above through a holistic approach. It’s holistic because we’re both looking at improving the supply of health services as well as increasing demand for them, whilst working with the local government to strengthen the health planning and leadership in the county.
The programme has been supporting essential services through training health workers, and improving their equipment and supplies. But one of the most significant issues it has been addressing is the cultural and social norms of communities.
Spreading the message loud and clear
Being able to work with the local government has enabled us to reach a wide and varied audience. For example, since June 2015, the programme has been supporting the airing of a radio programme on Nyota FM, one of the local radio stations in Bungoma County. Aired messages were designed to address the social and cultural barriers to women seeking formal health care. Through live theatre sessions and interactive call-in segments, challenging subjects were discussed. Communities have been engaged on issues such as the process involved in developing an individual birth plan, planning a means of transport before birth, to making savings for future expenses.
And the focus isn’t only on women. Community health workers are also speaking to husbands through men’s community meetings (or barazas). These provide men and fathers-to-be with the opportunity to explore some of the beliefs and practices that inhibit safe maternal healthcare. At this safe space it is also important to make sure traditions and cultural aspects are respected and so key messages are delivered by traditional birth attendants, who are often highly respected in the community.
Telling local stories
After three years of working with communities in Bungoma, we are starting to see incredible impact. Beyond the striking number of 25,000 babies helped so far, local stories have become living proof examples of what working with both the health services and communities can achieve and the pillars that will enable the programme to be sustainable.
Mckline was the very first baby to be born at a Ministry of Health facility in Bungoma County supported by the programme. His mother visited the nearby clinic seven times before delivery for antenatal care including birth planning, and after a healthy birth, Mckline was vaccinated free of charge.
At 20 months old, he’s happy, healthy, active and an incredible success story for the programme. When asked about changes in maternal health in her community, Mckline’s father says: “Baby Mckline has set a good example to our neighbours. The fact that he is growing up healthy makes people curious. Many mothers come to consult my wife. They accept her advice to go to hospital whenever their children are sick, and even attend clinic when the child is small.”
Trust and scalability
The programme’s success is measured exactly on this; generating a trusted and sustainable system which can be replicated across Kenya, and achieve true change for future mothers and children.
GSK’s early support for the programme is allowing Save the Children to gather and provide evidence of successful interventions. This evidence and knowledge will be used to persuade others (such as local governments and NGOs) to replicate them at scale, both within a country and across countries.
And we’re also working together on the ground, through the deployment of a GSK employee for 6 months through GSK’s PULSE Volunteer Partnership. Using their supply chain expertise they improved the processes for the procurement and supply of medical products in Bungoma County, and started to implement recommendations.
Working together on a large scale programme from such an early stage has taught us that to reach our ambitious target we need patience. As two very distinct organisations, our resources, knowledge, and links within countries are very different. It’s through leveraging the benefits of our core business strengths that the biggest breakthroughs can be achieved for thousands of children such as baby Mckline, and for mothers-to-be and families.