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Implementing free delivery uphill task

09 July 2013, 10:10 Stephen Ingati and Fabian Mangera

Nairobi - Many Kenyans were excited when President Uhuru Kenyatta ordered that maternity fees for mothers who deliver in public hospitals be abolished. But the celebration was short lived as people started to realize that the challenges go far beyond a waived fee.

Uhuru announced that his government will waive maternity fees at Kenya's Independence Day on June 1 this year. While hailing it as a noble idea of the government, some now say it only scraps the top of a bigger problem that is related to maternity health, especially in the remote areas in northeastern.

The challenges

"Maternity fee is not the only challenge that mothers face during delivery. The high rates of mortality deaths have become a matter of concern and major threat to women at child birth," said Mohamed Ibrahim, a doctor at the Garissa Provincial General Hospital (PGH).

PGH statistics show that only 5 percent of the population in the northeastern region have access to health facilities for delivery. The remaining 95 percent rely on traditional birth as their only hope in ensuring safe delivery for both mother and child. A 2010 report shows between 1,000 and 1,200 women die during delivery per 100,000 deliveries in Kenya's north, which also leads the rest of the country in child mortality rates.

According to Ibrahim, this poses a challenge to reaching the UN development goal of reducing mortality by 75 percent by 2015.

"This rate is highly unacceptable. And the main reason is because women have little or no access to healthcare facilities due to the long distances needed to travel to access health facilities. Some shy away simply because they cannot afford to pay for the health care services and sometimes it's just because of ignorance," said Medical Superintendent Musa Mohamed at the PGH.

Speaking in an interview with Xinhua, the superintendent said that the high mortality rate in Kenya's northeastern province can be drastically reduced if women seek delivery assistance from trained medical professionals.

Amina Mohamed, a resident of a remote village in Garissa called Bula Skedek, said some health facilities, especially in far flung areas, are inaccessible and the mode of transport is equally rudimentary.

"I was personally forced to deliver by the roadside as the vehicle that was to come and take me to the hospital came five hours later, this is because of the poor roads to my village, that is 200 km from Garissa town," said Mohamed, a mother of eight children.

"In case of a complicated delivery, that even traditional birth attendant cannot handle, we still have the challenge of accessing facilities that can offer cesarean sections or handle emergency services when a woman is having complicated delivery," she said.

According to Northeastern Province Medical Officer Dr. Mohamed Sheikh, efforts have been made to encourage women to seek professional care during child birth, including the construction of special maternity wings.

So far one maternity wing commonly referred to as a maternity shelter is operational at the PGH.

The ministry of health projected that about 500 mothers would use the facility by the end of 2012 since it opened in 2007; however, only 60 deliveries occurred at the facility during that period.

Reasons of the low attendance have been cited to lack of awareness of the facility's presence, ignorance, and inaccessibility of this service in terms of distance and costs.

"Article 26 in the bill of rights speaks of the right to life. It states every person has a right to life. It is in this context that we must look at the maternal health with a microscope that will go beyond maternity fees and address issue of maternity mortality," said Northern forum for Democracy Coordinator Khalif Abdi.

Hospitals overwhelmed

PGH's matron Khatra Ali welcomed the latest move by the government to alleviate the burden on expectant mothers, but called for a quick recruitment of nurses to help ensure that the initiative becomes a success.

"Since the maternity fee was waived, we have noted a spike in the number of women coming to give birth in the hospital. This is a very good thing as it will help reduce maternal mortality which is still high in this region," Khatra told Xinhua.

"The biggest challenge now is to ensure that the few nurses we have do not experience a burnout as we have only two nurses per shift caring for ten mothers and they used to attend to only about four."

She said that the hospital had a shortage of about 150 nurses and out of the 74 nurses currently at the hospital, only 12 were assigned to the maternity ward, a rate well short of the one recommended by the World Health Organization.

"Female genital mutilation which stands at 99 percent in this region presents another big obstacle to home births," said Musa.

He added that more than 90 percent of women in the region require caesarian operations for at least one of their deliveries because of female circumcision.

"Female circumcision practice in the region tampers with the natural exit, leading to the baby getting foetal distress and possibly dying if a cesarean section is not performed," Musa told Xinhua.

"Most turn to hospitals very late when home deliveries go horribly wrong," he said. 


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