Portable ultrasound devices could improve maternal health outcomes in Kenya, but cost remains a barrier

In 2022, Caroline Ochogo and her newborn son faced a life-threatening situation that required emergency surgery at Mfangano Island Level 4 Hospital in Suba North, Homa Bay County. What ultimately saved their lives was a single ultrasound scan.

“That experience opened my eyes to a whole new world of pregnancy that I didn’t know about before,” Ochogo reflects. "After undergoing emergency surgery, I realised that just one ultrasound scan made all the difference. It saved both my life and my baby’s life from pregnancy complications. I had no idea how critical it could be."

Now, as Ochogo’s due date for her second baby approaches, she’s preparing with a sense of calm and confidence. “I've finally let go of the fear and worry that others instilled in us during my previous pregnancy,” she says.

“This time, I’m ready to walk into the labour ward, have the baby, and embrace the experience we’re meant to have because I’ve been attending antenatal clinics regularly and taking routine ultrasound scans.”

According to Dr Amos Otara, a Nakuru County-based gynaecologist, ultrasounds during pregnancy are essential for monitoring the development of the fetus. “It is a medical test used to show images of soft tissues such as the liver, kidney, pancreas, and gall bladder. During pregnancy, it helps to check the baby’s age, growth, heartbeat, muscle tone, movement, and overall development."

He adds, "Ultrasound can detect abnormalities and ensure the baby is growing properly. While not 100 per cent accurate, it's non-invasive, painless, and safe for both the mother and the unborn baby."

The Ministry of Health’s Department of Reproductive Health highlights the benefits of routine ultrasound scans, which can reduce unexpected breech births by 70 per cent and lower the risk of babies being born with severe health complications.

Ochogo’s story mirrors the experiences of many women in rural Kenya who miss out on these life-saving benefits due to limited access to prenatal care and ultrasound services. In these underserved areas, the absence of such critical healthcare often results in the loss of babies—or tragically, the mothers themselves. 

Kenya's National Guideline for Self-Care Interventions in Reproductive Health recommends that pregnant women undergo at least two ultrasound scans. However, traditional ultrasound services have been limited to larger hospitals, mainly in urban centres, due to the cost and need for specialized radiologists or sonographers.

Recent advancements in technology, particularly Point-of-Care Ultrasound (POCUS), are changing that. POCUS devices are portable and can be used at the patient’s bedside, making ultrasound services more accessible in remote and underserved areas.

They allow healthcare workers, such as nurses and midwives, to make immediate and life-saving decisions during pregnancy.
However, despite the availability of this technology, the implementation of POCUS in Kenya’s Lake Region Economic Bloc (LREB)—which includes 14 counties like Bungoma, Homa Bay, Kisumu, and Migori—has been slow due to budget constraints and logistical challenges.

A study conducted between August 2023 and February 2024 by the Kisumu Medical and Educational Trust (KMET) and other partners surveyed 209 pregnant mothers and 198 nurses at antenatal clinics across the LREB. The findings revealed that only 32 out of 198 sampled health facilities provided POCUS services.

One of the main barriers is the high cost of the devices. A handheld POCUS unit costs around Sh400,000, while the most advanced models can reach up to Sh4 million. Given that there are more than 1,000 health facilities in the region, equipping each one with POCUS technology would require substantial funding.

"If each of the 14 counties in the LREB were to purchase these devices at the lowest price, we would collectively need KSh 400 million to serve the one million mothers who deliver in our facilities annually," says Dr Donald Mogoi, Nyamira Health Executive.

But beyond financial constraints, a lack of trained personnel is also a significant challenge. According to the study, only 9 per cent of nurses in the region are trained to use POCUS devices, leaving many facilities unprepared to utilise the technology effectively.

“We can’t maximise the potential of these devices without properly trained staff,” explains Dr Mogoi. “Training is just as important as the technology itself.” To overcome these barriers, some health executives in the region are advocating for creative solutions, including lease-to-own models for POCUS devices and integrating the technology into Kenya's Social Health Insurance Fund (SHIF) to ensure services remain free for pregnant women.

"We need to find ways to lower the initial costs," says Ruth Koech, Nandi County’s  Health County Executive Committee (CEC). "If we adopt a lease-to-own model, counties could eventually own the devices without the massive upfront investment. This could save lives by detecting complicated pregnancies early."

Dr Benard Wesonga, Health Executive in Kakamega County, emphasises that training must be included in any investment package. "If we’re spending hundreds of millions on these devices, the suppliers should also provide comprehensive training for our healthcare workers."

The Ministry of Health’s Department of Reproductive Health is currently partnering with development organisations like ICRHK and Ushiriki Wema to develop new Obstetric POCUS Guidelines, which will expand the scope of practice for nurses, midwives, and clinical officers, enabling them to offer ultrasound services even at lower-level facilities. 

Traditionally, ultrasound services in Kenya have been limited to radiologists and sonographers, who are often unavailable in many healthcare facilities, especially at level one and two hospitals. This project, set to launch on September 12, aims to ensure that more women, especially in rural areas, have access to life-saving care.

“This initiative will transform maternal healthcare by empowering frontline healthcare workers with the skills and tools needed to save lives.,” says Mercylyn Mokeira, Executive Director of Ushiriki Wema.

Dr Jnah Maina from the Directorate of Health Products affirms that the MOH will develop relevant guidelines and standards for the training and mentorship of staff in the counties.

This will ensure that healthcare workers are adequately prepared to use and interpret POCUS data. Meanwhile, Dr Don Ogolla, Director of Medical Services in Kisumu County, believes that the sustainability of these critical services should be through the Social Health Insurance Fund (SHIF).

“Ultrasound services are part of the free services offered by government-sponsored insurance. Pregnant mothers should not be charged for these services at Level 2 and Level 3 healthcare facilities but the biggest challenge is how the small facilities  will be reimbursed.”

In response to these challenges, the Ministry of Health’s Department of Reproductive Health has partnered with the 14 County Executive Committee Members (CECMs) of Health from LREB member counties, as well as the Center for Public Health and Development (CPHD) and KMET, to map POCUS initiatives and develop a roadmap for its adoption in their counties.

The 14 health ministers from LREB have committed to supporting efforts aimed at providing an enabling environment for POCUS adoption. A communique signed in Nakuru City states:

"We commit to supporting the dissemination and implementation of the guidelines, including availing funds for training healthcare workers and ensuring POCUS services are part of the Social Health Insurance Fund (SHIF) benefit package."

The ministers also pledged to include POCUS in county budgets, ensure that healthcare workers are trained in using the devices, and integrate AI-powered POCUS into the essential medical equipment list to further improve service delivery.

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