Introduction: Improving Maternal, Newborn and Child health is a key global agenda and is a priority for the Government of Kenya as is reflected in its Vision 2030, the Constitution of 2010 and the Health Sector Strategic and Investment Plan 2014-18. Kenya has improved most of its RMNCAH outcomes (U5MR, IMR, CPR), However, the MDGs for maternal and child health could not be achieved as many challenges in coverage still remain and disparities continue to exist in service delivery (MMR target was 147/100,000).
Marsabit County: Marsabit is one of the counties with the highest maternal mortality and Infant deaths. Infant mortality rate in Marsabit County is at 47 per 1000 live births while Under-fives mortality is at 70 per 1000 live births (KNBS, 2009). The sustainable development goals targets reduction of under five deaths to at least as low as 25/1000 live births. Maternal mortality ratio is one of the highest in Kenya at 1127/100,000 whereas the national target is at 300/100,000.
|MMR (Maternal deaths/ 100,000 live births)||1,127||495|
|Neonatal mortality rate (deaths per 1000 live births)||24||22|
|Under 5 mortality rate (deaths per 1000 live births)||70||52|
Data Source: KDHS 2014, 2009 Census & DHIS 2
The County faces a great challenge in improving maternal health with 40 per cent of women delivering at home in 2017 (DHIS 2). Despite the concerted efforts by the County Health Department, Ministry of Health, the goal has continued to lag behind. Sensitization campaigns aimed at encouraging mothers to deliver in the nearest health facility under the supervision of skilled health workers has been spearheaded by the Ministry of Health and non-governmental organizations.
Project Description: The Project funded by Phillips Foundation is implemented in Saku, Moyale, Laisamis and North Sub-Counties, Marsabit County with focus on 20 Community units. The project focuses on strengthening the existing community–based interventions with the goal of using community health volunteers (CHVs) to complement the limited capacity of the health workforce, particularly for delivery of maternal and child health services. CHWs will be attached to health centres and provided with commodities, supplies and outreach kits.
Project Objective: To achieve reductions in mortality and morbidity, the project has three primary objectives:
- To strengthen maternal and child health in the identified villages, while increasing the quality of and demand for services with an intention of transition to scale;
- To systematize a community-based model for health service delivery in the project area, while improving quality, access, and equity; and
- To document, disseminate, and promote the improvement of community-based maternal and child health services, while meeting standards and norms of the County Community health strategy.
The key components of the project are:
Phillips CLC kit: The CLC outreach kit enables a community health worker to diagnose and to triage patients in the community whilst also referring and connecting them to the main healthcare network. It is important to stress that this diagnosis does not include treatment, but merely enables referral and prioritization.
Community based information system: Mobile phones with ODK application will support collection and dissemination of data from CHVs to Sub-County level for entry into DHIS 2
Motorbikes for CHAs: 20 motorbikes are distributed to support Community health assistants to coordinate Community health strategy including training and mentorship of CHVs.
Care group model: will be used to share health information on maternal, child health and nutrition with women in reproductive age.
Health promotion: Carried out through CHVs and Care groups, health promotion will be the hallmark of the project to change the health seeking behavior of the target community.
Strengthened Civil Registration and Vital Statistics (CRVS) Systems: Civil registration will be a key component of Project’s level services provided through CHA and CHVs. The Project will link Health workers (through birth notifications) to CRVS for processing birth registration for newborn as incentives to improve Skilled birth attendants.
- Increased 4+ ANC visits from 56% to 70% by 2020
- Improved skilled delivery from 69% to 70%] by 2020
- Increased immunization coverage of fully immunized children from 83% to 90% by 2020
- 3000 women counselled on Health, Nutrition & hygiene.