Delayed launch of clinical guidelines causing needless deaths

The guidelines on the clinical management of the big five causes of maternal mortality were designed in recognition of years of evidence-based research. [iStockphoto]

In my earliest years as a health activist, I would often ask Joseph Karanja, a seasoned obstetrician gynecologist from University of Nairobi, if I could attend his practicum training for nurses and clinical officers.

Prof Karanja indulged my curiosity most times and allowed me, a lawyer with no medical background, to quietly sit at the back and observe. He was generous with his knowledge, and I was given my own sample pawpaw or watermelon to cut for demonstrations.

Soon enough, the joke became that I had attended too many of these Continuous Professional Development practicums that I should now become a certified 'quack' with an honourary medical degree obtained from listening to his lectures.

Whilst 'Prof' as we fondly called him, is no more, I remain an imparted learner from his guidance on the five leading causes of maternal deaths amongst Kenyan women. He was adamant that women must never die from preventable causes and that where interventions could be made early enough, there is no excuse for delays.

The Ministry of Health is yet to launch vital policy documents that aim to address the top five leading causes of maternal injury and deaths. This is despite circulating invitations to partners indicating that the documents would be availed by June 29, 2023. There has been a lot of resistance from the Catholic Doctors Association to launch these guidelines.

This unwarranted delay has only prolonged the suffering of Kenyan women, and I can only imagine what the lack of clinical guidelines means to medics and as they have difficult conversations with their female patients.

Essentially, the guidelines on the clinical management of the big five causes of maternal mortality were designed in recognition of years of evidence-based research.

The data identified the top five causes as sepsis (infections), hypertension, obstructed labour, unsafe abortion, and post-partum hemorrhage (excessive bleeding after birth).

Over the years, the Health ministry has published piecemeal policies that addressed each of these five causes, mostly in separate documents. Where the Ministry did not have its own policy, medics heavily relied on WHO guidelines.

We have, for instance, a 2011 National Guidelines for Quality Obstetrics and Perinatal Care that has over the years been revised slightly. We also have the 2011 National Orientation Package for Targeted Postnatal Care, the 2002 Standards for Maternal Care in Kenya, and the contentious 2012 Standards and Guidelines on Reduction of Maternal Mortality from Unsafe Abortion.

The 2023 Clinical Handbook on the big five causes of maternal death is perhaps the first attempt by the ministry to address all five causes collectively in one document.
When launched, these guidelines will ease direction and implementation for trained health providers of several cadres in one combined document rather than appraising themselves with several pockets of information.

Further delays in releasing these guidelines encourages siloed solutions, compartmentalised information, and refusal to train medics on the latest technological advantages.

The writer, Ms Saoyo, is an Award-winning Health Policy Advisor and Human Rights Lawyer.