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Accelerating the Attainment of MDG 5 in Kenya: Focus on the 15 Counties with the Highest Burden of Maternal Deaths

13 August 2014

The Ministry of Health, with the support of UNFPA Kenya, Kenya Red Cross and the Council of Governors, will host a consultative forum with Governors to drastically reduce the rate of maternal deaths in Kenya.

Millennium Development Goal (MDG) 5 commits to improving maternal health by reducing maternal mortality by three quarters and achieving universal access to reproductive health. Globally, the maternal mortality ratio has declined by 47 percent over the past two decades, from 400 maternal deaths per 100,000 live births in 1990 to 210 in 2010. However, in Kenya, maternal mortality ratio remains at an unacceptably high level of 488 deaths per 100,000 live births. This ratio has almost remained constant since 1990 (Kenya National Bureau of Statistics and ICF Macro, 2010).

There are wide regional disparities in maternal mortality within the country, with maternal deaths representing about 15 % of all deaths of women aged 15-49 years, which translates to an estimated 6000 to 8,000 pregnant women dying every year. The disparities in maternal mortality between counties are considerable, where the county with highest maternal mortality has 20 times the deaths of that with the lowest. The fifteen counties with the highest number of maternal deaths and highest maternal mortality ratio contribute over 60% of the national total, and include the following counties: Mandera, Turkana, Wajir, Nairobi, Migori, Nakuru, Siaya, Kisumu, Homa Bay Kakamega, Marsabit, Lamu, Garissa, Taita-Taveta, and Isiolo

The causes of maternal mortality in Kenya, like in most parts of the world are hemorrhage, complications from hypertensive disease in pregnancy, sepsis and abortion complications. HIV related deaths (20%) comprise the largest proportion among the indirect causes. It is apparent that some of these counties also have some of the highest HIV prevalence in the country, for example, Homa Bay has an HIV prevalence of 27%.

The high maternal mortality ratio is due to low utilization of skilled care, with only 47 per cent of expectant mothers completing the recommended 4 antenatal care visits and 44 per cent receiving skilled care at delivery, while caesarean section rate is 6.2% against the recommended rate of 7 - 15%. The national maternal health roadmap to accelerate attainment of MDG 5 puts the target for skilled birth attendance at 90% by 2015. There is low coverage for basic emergency obstetric care at 9% while the comprehensive care is much lower at only 7%. The contraceptive prevalence rate (46%) has remained low; while the unmet need for family planning is still high at 26%. This is of great concern in a country with a very youthful population.

Other factors contributing to the high maternal mortality are shortage of health workers, inadequate health care provider skills and harmful socio-cultural practices.

Various strategies have been put in place by the Government through the Ministry of Health in an attempt to reduce the high maternal mortality. Most of these interventions have been generalized across regions yet each region has unique characteristics. This has been further compounded by the limited resources allocated towards maternal and reproductive health, which are then spread thinly across the country in the course of implementation and scale-up of interventions.

Recent case studies have demonstrated that great political leadership can dramatically influence the impact of health interventions that contribute to reduction of maternal mortality among other health outcomes, whilst strengthening health systems. In this context, the Ministry of Health together with other stakeholders has planned for targeted interventions in the 15 high burden counties, using the leadership of these counties to spearhead the aforementioned process. This county leadership is important in order to mobilize resources and coordinate other sectors that contribute directly or indirectly to the maternal health outcomes.

The Ministry of Health and her partners has therefore planned for a high-level forum that will sensitize the county leadership of the 15 high burden counties on high impact interventions that can reduce, and ultimately end, preventable maternal deaths.

AIM:

The aim of this High Level meeting is to sensitize the County Governors and Executives in charge of Health from the 15 counties on the need to prioritize maternal health issues in their respective counties and to galvanize new and existing partnerships to make commitments for accelerating reduction of maternal mortality as outlined in the MDG Acceleration Framework and Action Plan for Kenya, and the Country Accountability Framework for Women's and Children's Health.

OBJECTIVES:

  1. To sensitize Governors County Executives in charge of health, County Directors of Health and County Reproductive Health Coordinators on the need for maternal health issues to be prioritized during the county planning and budgeting processes.
  2. To share some key strategies and evidence-based high impact interventions that can be implemented by the county governments to accelerate reduction in maternal deaths.
  3. To consult with the county governments on support required to facilitate a multi-sectoral response to reduce the high maternal mortality in their counties.
  4. To share some of the low cost best practices that have successfully demonstrated an impact in the reduction of maternal morbidity and mortality.
  5. To generate renewed commitments from prospective donors, together creating innovation and opportunity for accelerating reduction of maternal mortality in the 15 counties.
  6. To chart the way forward for resource mobilization and coordination of the maternal health programme at county level.

EXPECTED OUTCOMES: 
At the end of the forum, the following are the expected outcomes:

  1. Short term county specific priority actions and strategies to reduce maternal mortality identified.
  2. Commitment to prioritize maternal health in the county plan and county budgetary allocation processes.
  3. Technical support plan developed with the national government and key partners for the 15 target counties.
  4. Commitments for financing agreed interventions for accelerating reduction of maternal mortality.
  5. Communiqué from the Governors of the 15 target counties committing to the reduction of preventable maternal mortality.

Dates: 27th and 28th- August 2014

PARTICIPANTS:

Participants will be drawn from:

  1. Each county will be represented by four participants: a) The Governor, b) County Health Executive, c) County Director of Health, d) Reproductive Health Coordinator
  2. H4 plus UN Agencies: RCO, UNFPA, UNICEF, WHO, UNAIDS, UNDP and UN Women
  3. NGOs: AMREF, Kenya Red Cross, Save the Children, World Vision Kenya, IRC
  4. Donors: African Development Bank, DANIDA, USAID, CIDA, Swedish (SIDA), DFID, JICA, BMGF, World Bank
  5. Private Sector: Lions Club Kenya, Safaricom Foundation, Private Sector Alliance, , Equity Bank, Unilever, Phillips, Kenya Association of Manufacturers (KAM)/Global Compact Network, Kenya