PCNs the magic bullet to ending maternal deaths
President William Ruto flanked by his Deputy Rigathi Gachagua (right) and Health Cabinet Secretary Susan Nakhumicha during the Presidential assent of the Universal Health Coverage Bills at State House, Nairobi on October 19, 2023.
What you need to know:
- About 800 women worldwide (20 in Kenya) died every day from pregnancy or childbirth complications in 2020.
- About 70 per cent of maternal deaths occurred in Sub-Saharan Africa (SSA), where Kenya is domiciled.
The United Nations Division for Sustainable Development Goals (DSDG), Department of Economic and Social Affairs (UNDESA), in 2015 shared a blueprint for peace and prosperity for the people and planet.
The 2030 Agenda for Sustainable Development is an urgent call to action by all countries in global partnership to improve health and education and reduce inequality with the common goal to eradicate poverty.
SDG 3 is “reducing the global maternal mortality ratio to less than 70 per 100,000 live births by 2030”. About 800 women worldwide (20 in Kenya) died every day from pregnancy or childbirth complications in 2020 with a measly global maternal mortality ratio (MMR) decline from 227 deaths per 100,000 live births in 2015 to 223.
About 70 per cent of maternal deaths occurred in Sub-Saharan Africa (SSA), where Kenya is domiciled. This is despite assisted childbirth by skilled health personnel globally rising from 81-86 per cent in 2015-2022.
Access to maternity and newborn care
At 59-70 per cent, SSA, even with limited access to these services, had the fastest growth. This is despite government initiatives like Linda Mama, Beyond Zero and a universal health coverage (UHC) pilot to improve access to maternity and newborn care.
Kingdon’s multiple streams theory posits that three streams of activity must be met in order to create (usually very narrow) window of opportunity to achieve sustainable and impactful policy change: The problem stream; the policy stream; and the political stream.
With no significant change in the reduction in Kenya, maternal deaths remain a leading cause of pain and socioeconomic disability.
Turkana had one of the world’s highest maternal mortality ratios (1,594/100,000 live births); it fell to 381/100,000 in 2019. In a yet-to-be-published landscape analysis by Amref Health Africa in Kenya, this was largely thanks to this year’s implementation of a differentiated (One Health) primary healthcare model (Kimormor) and Maternal and Child Health Community outreaches (Tolodoi-Edawa).
Achieving universal health coverage
The Kenya Kwanza government’s quest to implement the four-point agenda towards achieving UHC led to an expedited enactment of four critical laws: The Primary Health Care Act, 2023; Digital Health Act, 2023; Facility Improvement Financing Act, 2023; and Social Health Insurance Act, 2023.
The launch of the over 100,000 community health promoters (CHPs) and UHC with a focus on primary care networks (PCNs) on October 20 comes with palpable excitement. Health cabinet Secretary Susan Nakhumicha said the country will have at least 315 PCNs.
The model allows for a comprehensive provision of healthcare along a continuum of services from the households to the county referral hospital.
A CHP, using their toolkit, can establish critical contact with each of the 100 or so households within their jurisdiction, identify pregnant women on time, closely monitor their progress, screen for early warning danger signs during pregnancy and breastfeeding and make referrals for timely interventions.
Dr Wekesa, the chief of party at Amref Health Africa in Kenya, is a Health Systems Committee member at the International Federation for Obstetricians and Gynaecologists (Figo). [email protected].
