Unlocking universal health coverage in our frontier counties

By Mohamed Guleid | Thursday, Aug 30th 2018 at 00:00
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Devolution Cabinet Secretary Eugene Wamalwa and Kirinyaga County Governor Anne Waiguru are gifted with crates of vegetables by farmers during the Governors peer learning mission at Kwambila earthdam in Makueni County on August 27, 2018. [Photo: John Muia, Standard]

As Kenyans celebrate Eid-ul-Adha – the Festival of Sacrifice – I reflect on the sacrifices that countless parents, especially those living in marginalized regions of Kenya, have to make to ensure their children survive and thrive.

For many living in the north and northeastern counties (Frontier Counties), access to basic health care is not guaranteed.

In 2013, Mandera County recorded 3,795 deaths per 100,000 live births – almost double that of wartime Sierra Leone at 2,000 deaths per 100,000 live births – making it the worst place in the world to give birth.

As Kenya rolls out Universal Health Coverage (UHC), the Frontier counties must reassess their primary health care systems. In many ways, the first and most important step in the journey toward UHC is ensuring every individual accesses a functioning primary health care system.

Since devolution, the Frontier counties have made significant investments in improving access to health care – especially for pregnant women and newborns.

For instance, in 2013, more than three-quarters of women in Turkana County were giving birth at home.

Today, Turkana has doubled facility deliveries by introducing a traditionally-acceptable tool – a birth stool.

Similarly, Wajir County celebrated its first cesarean section in 2016 and Garissa County is investing in maternal shelters that act as waiting homes where women with high-risk pregnancies can be monitored and receive emergency care.

Others such as Lamu and Mandera counties are partnering with the private sector to increase access to modern maternity care services.

Health care

However, for the Frontier counties to see sustained progress in maternal and newborn survival, investments in access to health care must be accompanied by improvements in quality of health care.

When it comes to pregnancy and delivery, arriving at a health facility on time is not enough. The health facility must have qualified personnel, it must have essential commodities required for delivery, and it must be capable of dealing with emergencies that may arise.

Quality of care around the time of birth is critical as most lives are lost to preventable causes during this period. In Kenya, 75 per cent of all infant deaths occur within the first seven days of a newborn’s life.

Most of these deaths are due to birth asphyxia – a situation where an infant’s body is deprived of oxygen. Yet, simple birth techniques such as neonatal resuscitation and initiating skin-to-skin contact between the mother and the newborn go a long way in saving lives.

In addition, most women die giving birth due to excessive blood loss following childbirth. Early diagnosis of hemorrhage could save hundreds of women’s lives.

Crashing plane

As the Frontier Counties begin to map their vision for UHC, quality of care must take center stage. In the aviation industry, where mistakes can result in horrible fatalities, checklists have been adopted to ensure standards.

Pilots are trained to use checklists so that they can better respond to high-pressure situations such as a crashing plane.

About ten years ago, the health industry borrowed this checklist practice. Initially, the World Health Organization (WHO) issued a Surgical Safety Checklist for operating rooms.

Data published in 2017 in the Annals of Surgery showed that the checklist led to a 22 percent reduction in post-surgical deaths in pilot facilities.

WHOs Safe Childbirth Checklist is a simple tool that reminds health workers of essential practices that can improve quality of care during birth. Migori County is already piloting the checklist in 17 public hospitals and the Frontier Counties have an opportunity to learn from it.

Earlier this month, leaders from the Frontier Counties joined forces to ensure this rate of progress does not stagnate. Health CECs from Garissa, Isiolo, Mandera, Marsabit, Turkana, Wajir, Lamu, Tana River and West Pokot have formed a regional Sector Forum for Health.

The first of its kind in Kenya, the Forum will serve as an engine to drive inter-county collaboration, facilitate a healthy exchange of ideas and learnings, and track critical health indicators across the region to ensure no county is left behind.

This heralds a new chapter in the health agenda of this region, one that will bring about drastic improvements in health and wellbeing and set the Frontier Counties on a steady path to achieving Universal Health Coverage.

Mr Guleid is the Executive Director of the Frontier Counties Development Council (FCDC)

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