Experts urge Government to fix quality of care to curb maternal, newborn deaths

Experts have called for better quality care in hospitals to curb maternal and newborn deaths in the country.

They said this includes having enough health workers trained and skilled in maternity and child care, as well as ensuring hospitals have tests, medicines and other supplies.

Experts said many women reach hospitals on time but face delays in getting the care they need. In some cases, both the mother and newborn die.

Speaking during the Health Summit, LVCT Health Executive Director Dr Lilian Otiso said although women are getting to hospitals, they do not always receive quality care.

She said some health problems are identified but the right treatment is not always provided.

“If a woman is found to have anaemia, they are given iron tablets, including dewormers, antimalarials and multivitamins. We have a whole bunch of interventions that are to be given that we are not necessarily giving,” said Dr Otiso.

She said most tests required during pregnancy are not being done, apart from HIV testing, which is heavily supported by donors.

“To avert maternal and child deaths, there is need to fix the quality of care at facilities. In terms of maternal deaths, there are delays in diagnosis, delays in getting to facilities and, when you get to the facility, delays in getting care,” added Orison, also chairperson Health NGO Network (Hennet).

“We need to look at quality of care when women get to the facility for us to reduce maternal and neonatal deaths. This includes tests and commodities,” she added.

The call comes as the Government invests Sh12.2 billion to reduce maternal and newborn deaths.

First Lady Rachel Ruto said improving maternal and newborn survival will require adequate investment, skilled health workers, reliable equipment, functional referral systems and greater accountability across the health sector.

She said the Government’s Every Woman Every Newborn Everywhere (EWENE) Acceleration Plan 2026-2028 had given fresh impetus to efforts to eliminate preventable maternal and newborn deaths.

The plan seeks to expand access to maternal healthcare through the Social Health Authority (SHA), including increased availability of essential maternal and newborn commodities, family planning supplies, nurses and midwives.

In Kenya, about 15 mothers and 92 newborns die every day, according to figures presented at the summit.

Among the interventions by the Government is the rollout of primary healthcare networks, alongside the Social Health Authority (SHA) and digital health systems.

The digital system under SHA is expected to capture information from the time a woman becomes pregnant, through antenatal care (ANC) visits to delivery.

The summit also focused on primary healthcare, including the role of Community Health Promoters (CHPs), who are linked to health facilities.

CHPs refer patients from the community to health facilities and help ensure people receive primary healthcare services.

ANC was also a key area of discussion during the maternal health session.

A study by LVCT Health, dubbed “CHP Do”, found low attendance of ANC visits in Homa Bay County.

The study was conducted last year and released early this year.

Before the study, community health teams were trained to use data to identify challenges and find out why ANC attendance was low.

Communities were also involved in identifying their problems and choosing solutions.

About 1,400 people took part in the study. Of these, 700 were placed in the intervention group while 700 were in the control group.

The study found a four-fold increase in the number of women attending ANC in areas where the project was implemented compared to areas where there was no intervention.

The study also found that more women were able to increase the number of ANC visits.

The target is for women to attend ANC eight times during pregnancy.

“Through the intervention, we were able to increase four-fold. Even the four ANC visits were able to at least double,” said Dr Otiso.

“We got about 60 per cent of the women or more getting to the four ANC visits. For eight ANC visits, we were able to move from eight per cent to 44 per cent,” she added.

According to the 2022 World Health Organisation (WHO) guidelines, women should have eight ANC contacts during pregnancy.

The study recorded no maternal deaths in the areas where the intervention was implemented.

However, neonatal deaths did not change between the intervention and control areas.

Dr Otiso said this showed that the quality of care in health facilities needs to improve.

“There is need to work with facilities, ensuring health workers are available, motivated and have commodities,” she said.

She said one of the biggest challenges affecting ANC attendance is lack of commodities and laboratory services.

“This is a big gap. If you do not test, for example, you cannot tell if a woman has low blood count or anaemia. The chances of losing the pregnancy, the baby being born with anaemia or getting sick become higher,” said Dr Otiso.

“We need to have the tests so that during pregnancy we can give interventions like iron or treat conditions that cause anaemia, so that babies are healthy alongside the mother,” she added.

Common causes of newborn deaths include birth asphyxia, where a baby does not get enough oxygen during birth, infections and lack of oxygen during delivery.

Dr Otiso said community interventions can help reduce delays in reaching health facilities and help women know when they need care.

Strikes by health workers were also cited as a factor that can affect maternal and newborn health.

“When we have strikes, like at the moment, we are definitely going to see increased maternal and child deaths because women are being turned away,” she said.

Women who are turned away may fail to get tests and treatment, which can discourage them from returning for future visits.

“Strikes over the years have contributed to child and maternal deaths. In the country, we already have limited services and health workers. When they are on strike, it means it is even worse because women reach facilities and are not treated, and they end up going back home,” she said.

“Some of them end up delivering at home, which increases the risk of either the mother or child dying, or both.

They do not get the tests or commodities. It breaks down the system when you do not have health workers who are able to work. We therefore need to address the issue of health worker strikes and then address the broader aspects of quality care.”

She said the rollout of primary healthcare networks is a step in the right direction because it has improved referrals and access to ambulances in some areas.

“Those are very good steps but there is still more to be done to ensure that from the moment a woman thinks of getting pregnant to when she gets a child, she is well taken care of,” she said.

Dr Otiso also said preventing unwanted pregnancies is important in reducing maternal deaths.

She called for access to family planning services and commodities for women who need them.

She warned that shortages of family planning commodities could lead to unwanted pregnancies and unsafe abortions, which can cause deaths and other complications.

“For EWENE, we have to look at it along the entire cycle of a woman, from preventing unwanted or unplanned pregnancies, having access to the family planning choice that you want, and walking the journey with her through pregnancy and delivery,” she said.

Although there is no data directly linking shortages of family planning commodities to unwanted pregnancies and abortions, Dr Otiso said the problem could be contributing to the cases being reported.

CHPs, she said, are also key in maternal and child health because they encourage women to attend ANC.

The CHPs have equipment that can help identify a woman's health needs. They can also refer pregnant women from their homes to health facilities.

During the study, CHPs asked for pregnancy testing kits so that women found to be pregnant could be tested immediately.

The intervention increased pregnancy testing and referrals and helped improve ANC attendance.

CHPs also record information on pregnancies, areas where women are pregnant, skilled deliveries and home deliveries in their monthly reports.

However, Dr Otiso said referrals remain a challenge, with some women being asked to pay for services when they reach hospitals.

In some cases, women also fail to reach hospitals because there are no ambulances.

Otiso said LVCT Health and its partners are working to ensure people who are often left behind in maternal healthcare, especially adolescent girls, get the services they need.

She said adolescent girls need quality care whether they are pregnant or trying to prevent pregnancy.