Healthcare workers' competence is key to ending mother, baby deaths

Every birth should be attended by qualified competent health personnel. [iStockphoto] According to the latest World Health Organisation estimate of maternal mortality globally (derived from national data), the life time risk of death during pregnancy and childbirth in Kenya is 52, compared to 63 in East Africa, 40 in sub-Saharan Africa (SSA) and 210 globally. Of the estimated 287,000 maternal deaths that occurred globally in 2020, seven out of 10 occurred in SSA and 7,716 occurred in Kenya. Indeed, there has been 12 per cent reduction in maternal deaths in Kenya between 2010 and 2020, but more can be done to scale up access to quality maternity services at all levels. Data from the Kenya Ministry of Health Confidential Enquiry into Maternal Deaths, show that these deaths are preventable. Nearly three in every four maternal deaths are linked to direct causes such as bleeding after birth, hypertensive disorders, infections and other delivery-related complications. While most maternal deaths are preventable, only one-third of public health facilities are capable of delivering the seven life-saving signal functions of basic emergency obstetric and newborn care (EmONC). Every birth should be attended by qualified competent health personnel. The proportion of such personnel attending to women during childbirth in Kenya has increased from 43 per cent in 2000 to 77 per cent in 2020 but the Kenya Confidential Enquiry into Maternal Deaths showed that training to improve the quality of care is required. Therefore, governments at all levels must invest in quality and continuous training for medical teams that provide before, during and after childbirth. Women form the backbone of a nation's economy. As such, the outcomes of maternal health care are an indicator of a country's healthcare system. In our devolved system of governance, health indicators related to women and newborns health outcome must record progress- we must leave no county behind, underpinning the importance of universal health coverage. While major progress has been made over the past two decades to improve mortality outcomes in women and newborn - major disparities remain in survival rates around the time of birth for mothers and infants born in high, middle and low-income countries. A significant gap continues to exist between actual and achievable health care outcomes, primarily because effective interventions are not implemented for every patient, every time. Across all the 47 counties, there still remains key glaring gaps which include a lack of readiness and functionality of the health system, inadequate skilled human resources for health, gaps in the quality of care, inequitable geographic distribution of services, high levels of unintended pregnancies, particularly among young women, and gaps in financing and affordability of healthcare for many households. Notably, the Covid-19 pandemic further disrupted access and utilisation of key Maternal and Newborn Health services, underscoring the need for health system resilience and strengthened capacities for preparedness and response. Insufficient access to high quality antenatal care, along with barriers to emergency obstetric care, including cesarean sections, contribute to maternal health challenges in many of our public health facilities in Kenya. Kenya has made significant strides in improving maternal and child health outcomes, but a lot still needs to be done to address the supply and demand barriers in the delivery of maternal and new-born health services. The devolved structure of the Kenyan health system has provided an opportunity to address the longstanding systemic inequities and inefficiencies in the health system. County governments have given priority attention to expanding primary health care services, hence increasing access to preventive and promotive health services. At national level, the government has embarked on health financing reforms to increase budgetary allocations to maternal and newborn health and improve access and utilisation of the services. The first Confidential Enquiry into Maternal Deaths in 2017 and subsequent reports outlined recommendations for improving maternal health. National and county governments should strengthen the Maternal and Perinatal Death Surveillance and Response (MPDSR) system - a quality improvement system to pick lessons from cases of mothers and babies who die during pregnancy and childbirth and ensure resources are allocated to implement action plans. A quick look across counties, the actions from MPDSR touch on in-service training of healthcare workers on EmONC; integration of EmONC and MPDSR training modules in pre-service training syllabus/curricular for nurses, clinical officers, and medical doctors; and increasing access to blood transfusion services. Global evidence shows that midwives can help to substantially reduce maternal and neonatal mortality and stillbirths in lower middle-income countries. However, to realise this potential, collaboration is key to ensure policies formulated by the national government are supporting and enabling county governments to roll out initiatives that build and strengthen capacity of health workforce. -Dr Ameh is co-director, WHO Collaborating Centre for Research and Training in Maternal and Newborn Health, and Head International Public Health Department, Liverpool School of Tropical Medicine, UK

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Healthcare workers' competence is key to ending mother, baby deaths

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