The Safe Maternity Plan (Umama Salama in Swahili) has two primary areas of focus: to build infrastructure and human capital. The physical infrastructute of the Lwala Community Health Center will be tripled through the building of a dedicated maternal health wing. This 500 square meter wing will contain rooms for maternal child health, maternal education, patient intake for labor, delivery and recovery, offices for on-call clinicians and administrative staff, space for clean and dirty utilities, bathing, and toilets. This wing is in the pre-construction phase as blueprints have been drawn, partial funding has been raised, and contractors are offering bids. The groundbreaking of the project is projected for October 2009. The second focus area is to increase basic emergency maternity knowledge in the local community and the clinic staff. This is being accomplished in the community through a curriculum of Home Based Life Saving Skills, which has been used to train 12 local traditional birth attendants who are now beginning to hold community training session. Over time this outreach will increase exponentially. The clincal staff's knowledge is being increased through continued medical education from both local training resources and visiting OB/Gyn experts from Dartmouth and Vanderbilt.
The major costs associated with this initiative will involve a capital investment for the construction of facilities, while recurrent expenses for staffing, medicines, quality improvement projects, and equipment will constitute long-term costs.
This commitment will save lives of infants and mothers in rural Kenya and serve as a model of best practice for possible expansion to other areas within the country that face similar challenges within the field of maternal health.
The following statistics underscore the severity of this health burden within the country:
The maternal mortality ratio in Kenya is estimated to be 560 maternal deaths per 100,000 live births. Maternal deaths account for 15% of all female deaths in Kenya and the Ministry of Health reports that more than 500,000 women suffer physical injuries during pregnancy and childbirth. As many as 194,000 of these injuries may be life-threatening. The infant mortality rate in Migori District (part of which is now Rongo District) is estimated at 137 infant deaths per 1,000 live births. This is pertinent to the population of interest for the Safe Motherhood in Lwala commitment: women of reproductive age (15- 49) in the catchment area of the Lwala Community Health Center. The catchment area has been defined as approximately those individuals living within Rongo Division of Western Kenya, which is made up of five Locations: North, South, East, West, and Central Kamagambo.
Risk factors for maternal morbidity and mortality among this population include early marriage, low contraceptive prevalence (75% of currently married women in Nyanza Province do not use any form of contraception), high total fertility rate (5.6), and gender disparities in education, economic independence, and decision-making power. Luo culture is patrilineal, patrilocal, and polygamous and the status of women is low. Teen pregnancy rates are high and young teenage mothers are not sufficiently informed about safe motherhood practices. Further complicating this isssue, since extra-marital pregnancy is considered shameful, few adults discuss pregnancy with teens thus an educational gap inherently exists.
A study among a population living in the catchment area of Lwala Health Center showed that of women coming to a health center for antenatal care, 36% had peripheral malaria parasitemia, 53% were anemic, and 76% had geohelminth infections. Of the 87% who had previously given birth, 55% had ever lost a live born child.
This quantitative evidence is further supported by anecdotal experience through the provision of services at the Health Center. For instance, demand is high for emergency obstetric care at the Lwala Community Health Center; even without a dedicated maternity wing. Women with birthing complications have been visiting the facility since its opening in April 2007 despite the fact that the facility and staff are not adequately equipped to provide safe maternity care. In order to strengthen its capacity, the Lwala Community Alliance has identified the issue of maternal health as a critical component to its mission to enhance the well being and health of the community. It is therefore committed to build a dedicated maternity wing and conduct extensive community health outreach through a curriculum of Home Based Life Saving Skills that will not only foster future community leaders who are well-trained and educated about safe motherhood practices but also promote preventive measures that will have a direct impact on the health and well being of mothers and their children.
Lwala Community Alliance is offering best practice information in relation to utilizing traditional birth attendants to increase facility based delivery in rural settings.
Lwala is also seeking financial and technical resources to extend the success of the Safe Mothers, Safe Babies program by launching 'Thrive thru 5', a follow-on project to cut under-5 mortality in half by the end of 2016. To do this, Lwala must guarantee babies are born safely and protect growing children from the most common regional threats of mortality: malaria, HIV, diarrhea, pneumonia, measles, injury, and malnutrition. 'Thrive thru 5' will ensure that (1) 98% of pregnant women access prenatal care and deliver in a health facility, (2) 100% of newborns receive care after delivery, (3) 90% of children under 12 months are fully immunized, (4) 7,000 children under 5 have access to affordable primary care, and (5) local health workers are leading the effort.