However, in the last two years, the hospital has not recorded a maternal death, moving from as many as 4 to none per year. The hospital also experienced the greatest reduction in perinatal mortality (the deaths of children a week after they are born) from 398 to 251. Neonatal mortality, the death of babies if it occurs 28 days after birth, is reduced by more than 400 per cent from 26 to 5.
At its location, Kibwezi Subcounty Hospital is on the periphery of the county and is the only Comprehensive Emergency Obstetric and Newborn Care (CEmONC)facility. This is because, on top of other services needed to save a mother, the facility also offers Caesarean section operation.
Patricia Musau, the Nurse-midwife and manager at the facility, says they often receive severely ill mothers and babies in critical condition from very far to the hospital.
"We receive all sorts of cases, excessive bleeding, ruptured uterus, and all sorts of obstetric emergencies," Patricia reveals.
As a CEmONC facility, Patricia and the team can often handle some of the cases that land at their door.
Others may need surgical care too advanced the hospital is not equipped to handle. In the process of referral to the county's largest facility in Wote - Makueni County Referral Hospital - the mothers often do not endure the two-and-a-half-hour drive.
"The time in referral, such as delay in the patient being brought here, and then when they are here prepping the ambulance which may have even rushed another patient for care, or we have run out of blood... these delays can be the undoing of the mothers and their babies who do not have time," Patricia says.
Death during referrals for mothers is a common public health challenge in Kenya. A 2022 study in the journal BMC Pregnancy and Childbirth, which investigated the deaths of patients in Migori, attributed these deaths to delays that cause the death of anyone seeking emergency care.
"Delays in the community or the patient deciding to go to the hospital, delays caused by infrastructure like roads, and delays in receiving quality care in poorly staffed and equipped health facility," part of the report says.
Like most public health facilities, Kibwezi experiences stockouts of life-saving commodities like blood the patients they receive.
The ambulances are also few, to cater for a huge population. As the facility's management team and the county's health department stared at the ghastly statistics of death, the county needed solutions fast.
Working with a research project from the John Hopkins Affiliate, Jhpiego, the Antenatal and Postnatal Care Research Collective (ARC), Makueni County mapped what resources they had nearer Kibwezi.
"One time I had a mother here who needed blood urgently, and we knew she would need intensive care later; we called Kilungu who put the blood in their ambulance and brought it to us, and Dua Hospital which is a private hospital sent their ambulance and emergency team to take the mother to Makueni County Referral," Patricia says.
Dr Stephen Ndolo, Makueni County's Chief Office of Health said that the documents are one of the county's ways to ensure that referral is not shifting burden to another health facility but a continuation of care.
The Ministry of Health's 2017 investigation into what kills mothers revealed that 50% of the mothers who had died had been patients who had been referred from a low-level facility to a higher one, and "poor record keeping and documentation was noted in most cases of maternal death."
Nurse-Midwife Loise Nzilani, who heads the nursing and midwifery care at Makueni County Referral Hospital says she and her team would receive mothers and babies who are already unconscious
In 2021, Makueni County had one of the highest maternal mortalities and 479 deaths per 100,000 live births, according to the Kenya National Bureau of Statistics.
The Department of Health Services in Makueni received the highest budgetary allocation, which was 34 per cent of the total County budget for the fiscal year 2023/2024.