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Transforming Mandera County’s Deadly Reputation For Maternal Health

By Siddharth Chatterjee (@sidchat1) - UNFPA Representative to Kenya.

For many women in Mandera County a hard to reach, insecure and arid part of North Eastern Kenya, the story of life from childhood to adulthood is one about sheer pain and struggle for survival.

As little girls, they undergo female genital mutilation (FGM), a painful carving out of the external genitalia that leaves them with lifelong physical and psychological scars. 

Most girls will be married off when barely into their teens, forcing them to drop out of school, their immature bodies thrust into the world of childbearing.

As a result, Mandera – just a two-hour flight from the dynamic, modern East African hub of Nairobi – has maternal mortality ratio of 3,795 deaths per 100,000 live births that surpasses that of wartime Sierra Leon (2000 deaths per 100,000 live births) as well as the Kenya’s nationalaverage (448 deaths per 100,000 live births).

Mandera is an example of a community marginalized combined with internecine conflicts, pockets of extremism, poor human development, cross border terrorism, which has trapped its people in poverty, misery and desperation. Cultural norms like status of the women, FGM and child marriage makes it worse. Among the poor, inequities hurt women and girls most. 

However, things are looking up. Kenya’s decision to devolve government, putting much more power in the hands of local authorities, is having an impact on the ground.  Indicators such as number of health facilities offering basic maternal and child health, and the number of women giving birth in a health facility are improving.

Just as critical to these improvements is the recently established private sector’s coalition to transform the health landscape of this county, long considered a lost frontier.

The goal of this coalition is to develop new products and service delivery models, likecommunity life centers(CLC) to improve maternal and new-born health among most vulnerable populations in Kenya.

An inter-agency team consisting of the Office of the President of Kenya, Ministry of Health, Kenya Red Cross, UNOCHA, Save the Children, technology company Philips, Amref, Safaricom, GlaxoSmithKlein and UNFPA visited Mandera on 13th October 2015 with the Ambassadors of Turkey and Sweden to Kenya to launch a Ministry of Health-UNFPA–Philips Innovation partnership.

The UNFPA and Philips CLC project, is expected to bring quality primary healthcare within reach of about 25,000 population with small improvements enhance that functionality of health facilities like 24-hour lighting that will allow facility deliveries to take place and sick children attended after dark. If successful, this initiative could be scaled-up and transform maternal and child health in Mandera county.  

Mandera has long remained out of bounds for most international UN staff and diplomats due to insecurity. Hopefully the visit by the Ambassadors of Turkey and Sweden, who are ardent advocates of the rights of women and children, will pave the way for more visits to all the North Eastern counties which face similar challenges.

The Ambassadors spoke of their countries’ commitment to work with the county to change the narrative, especially to advance the rights and wellbeing of all women and girls.

The broaderpartnership which also includes Huawei, Kenya Health Care Federation, MSD, together with the United Nations’s H4+ partners will focus on the 6 counties with a high burden of maternal mortality: Wajir, Marsaibit, Lamu, Isiolo, Migori and Mandera. 

The main activities in these 6 counties will include strengthening supply chain management for health commodities, increasing availability and demand for youth-friendly health services, capacity building for health professionals, youth empowerment and research.  These activities be complemented by the results based financing supported through the Health Results Innovation Trust Fund managed by the World Bank.

It is also in line with the full-scale Kenyan government commitment to reduce maternal deaths and the new polices of free maternity care and user fee removal. 

Kenya's First Lady Margaret Kenyatta once remarked that “I am deeply saddened by the fact that women and children in our country die from causes that can be avoided. It doesn’t have to be this way,” she said. “This is why I am launching the ‘Beyond Zero Campaign’ which will bring prenatal and postnatal medical treatment to women and children in our country.

The dividend from healthier women will be a more educated and healthy society, with more economic opportunities and reduced exclusion which will engender peace and hopefully reduce the drivers of violent extremism.

It will be a major score for Mandera towards fulfilling the vision of UN Security Council Resolution 1325 which is about empowerment and participation of women, ending discrimination and the scourge of harmful traditional practices like FGM and child marriage.

The launch in Mandera has shown that led by the National Government and the county authorities, the development partners and the private sector have their shoulders squared for the job at hand; clearly becoming a global force for good and makes good business sense.