By Sharon Atieno
By the time Sharon Igunza, 20, was three months pregnant, she had not gone to any health facility to start her antenatal care (ANC).
It took the visit of the local community health volunteer (CHV) to her home in Sabatia sub-county, for her to start attending ANC at the Sabatia sub-county hospital.
She did so faithfully until she gave birth seven months ago. “Were it not for the CHV encouraging me and sensitizing me about the importance of going to the clinic for me and my unborn baby, I probably would never have gone,” Igunza admits.
The United Nations International Emergency Fund for Children (UNICEF) notes that ANC is essential for protecting the health of women and their unborn children.
Further, the World Health Organization (WHO) recommending at least four ANC visits during pregnancy observes that by implementing timely and appropriate evidence-based practices, ANC saves lives.
ANC provides a platform for micronutrient supplementation, treatment of hypertension to prevent eclampsia (seizures occuring during pregnancy or shortly after giving birth), immunization against tetanus and preventing mother-to-child transmission of HIV.
Besides ANC, skilled health personnel attending every birth, postnatal care (PNC) within two days and care for small and sick newborns are among the measures endorsed by the 194 WHO Member States to end preventable infant and maternal mortality and morbidity by 2025.
Sabatia sub-county is among the five sub-counties in Vihiga County. The county, located in Kenya’s western region, is home to about 638,000 people.
A programme rolled out by the governor, Wilber Ottichilo, in 2018 has helped to reduce maternal and infant mortality in the county.
Boresha afya ya mama na mtoto (improve the health of mother and child) programme has reduced maternal mortality from 531 deaths in 2018 to 344 in 2023. The infant mortality rate has decreased from 19 to less than four.
The programme coordinator, Vihiga County, Salome Sumba noted that even the crucial health indicators for maternal and infant health have improved.
Between 2018 and 2023, the first ANC attendance increased from 42.9% to 99% while the fourth ANC rose from 35% to 70.9%. Immunization rates have also improved from 48% to 96.5% while skilled delivery has risen from 68% to 90.9%.
“Women are coming to the clinic early. They are keen on following the steps from antenatal, delivery, postnatal, family planning and immunization. They have also understood that they need to be healthy to get another pregnancy thus, adhering to at least a two-year spacing between pregnancies,” said Sumba.
The programme, she adds, only caters for mothers from Vihiga County or those that have stayed in the county for more than six months.
For the woman to be enrolled in the programme, she must be 16 weeks pregnant or less. Also, being that there is a component for cash transfer, the woman must own a telephone number which is active and can receive mobile money to help cater for her health needs including buying fruits and transport to the health facility.
The programme is being rolled out in 24 health facilities across Vihiga County. Once an eligible pregnant woman visits any of these facilities, her data is uploaded into the programme’s system. These include basic details such as name, telephone contact and location which are collected by a data clerk or nurse.
The programme has leveraged the national CHVs programme and has recruited more than 200 CHVs to be part of it. Each of these CHVs has an app that is installed on their phones which helps with data collection.
According to Sumba, the programme operates online using an integrated management information system. Hence, once the data is uploaded onto the system at the facility, the CHV in the particular location where the woman comes from receives a notification in their personal account which has details of the newly registered mother.
Harriet Asuza, CHV in Butali Village, Sabatia sub-county notes that upon receiving this information, they arrange a meet-up with the woman in her home. They then collect more information from her including her socioeconomic status, family background, next of kin as well as their global positioning system (GPS) location.
The woman is then sensitized on the importance of attending antenatal clinics and what impact it has on her health and the baby. They are also given other health promotion messages. Follow-ups are done consistently throughout the pregnancy period until the baby is around 18 months or more, Asuza who has worked under the programme for more than four years says.
“Before we started this work, a lot of women were giving birth at home. There were so many deaths of either the mother or the baby or both,” she recalls. “But now because they are coming to the clinic in good time and giving birth in hospitals, the rate of deaths has reduced.”
Though the women are encouraged to go for eight ANC visits and follow-up is done to this effect, cash transfers are made only five times. This is during the first and fourth ANCs, delivery, when the baby is six weeks old and at 18 months. During these instances, the mother’s fingerprint is collected for verification.
Upon delivery at the hospital, the women receive a mama pack which includes clothes, a towel and a basin for the baby, an African sarong for the mother and something small for the father to appreciate him.
The CHVs also follow up to ensure that the baby has received all immunizations until 18 months. The other aspect of the programme is supporting the mother in acquiring a birth certificate for the child within the period they are enrolled.
Despite this, Asuza notes that some mothers give incorrect information at the facilities. This includes the wrong physical address which makes it cumbersome to find them when they organize a meeting. Some also give incorrect telephone numbers, thus they cannot be reached.
Additionally, the women are only allowed to enrol on the programme again when the baby has reached two years and they can only benefit from it for only three pregnancies.
The registration started with 50 mothers and has spread to 12,850. Of these, 3000 have exited because their babies have reached two years and above.
