Mothers Matter: Obstetric Safe Surgery in Kenya
Summary
In 2025, the Global Surgery Foundation (GSF) committed to expanding access to safe cesarean section (CS) to more than 465,000 women and newborns across four counties in Kenya where 71% of facility-based maternal deaths are associated with CS. Through their comprehensive, woman-centered, integrated approach, the GSF will implement a hub-and-spoke training and blended mentorship model using their award-winning online learning platform SURGhub to strengthen the capacity of surgery teams – including obstetrics, anesthesia, nursing, and midwifery – across 20 high-volume health facilities by 2029. Facility readiness will also be assessed and gaps identified to address functional readiness. Data collected will be used to inform decision-making and quality improvement activities within and across facilities and counties, and community health promoters will facilitate timely access to emergency obstetric care and safe surgery recovery. Working in partnership with the Ministry of Health, this commitment will validate further scale of this model.
Approach
Based on the success and lessons learned from the Obstetric Safe Surgery (OSS) project in Makueni County in Kenya, the Global Surgery Foundation (GSF) commits to deploy a comprehensive integrated approach to address challenges to safe caesarean section (CS) in three additional counties, across five high-volume facilities in each county, in Kenya.
The technical and non-technical skills of interprofessional surgical teams will be strengthened through a hub-and spoke training and blended mentorship model. The project will leverage the award-winning online learning platform SURGhub, for all facility surgical teams, across disciplines of obstetrics, anesthesia, nursing and midwifery, through a women-centered approach.
Improving the culture around data collection and quality of data will be part of the initial training and ongoing monthly mentorship activities (in-person and virtual) , and data collected will be used to inform decision-making and quality improvement activities within and across facilities and counties.
This project will ensure facility readiness by conducting rapid assessments in health facilities and addressing identified gaps to ensure functional readiness to impact both quality and experience of care. Furthermore, networks of care and referral systems will be strengthened by reinforcing effective communication and leveraging existing platforms.
Additionally, communities in the catchment areas will be engaged through community health promoters (CHPs) to facilitate timely access to emergency obstetric care and in follow-up of mothers and newborns following CS to reinforce self-care, identify and refer women with complications following CS, and identify and refer newborns with danger signs.
To ensure long-term scale and sustainability, project teams will collaborate with County Health Management Teams (CHMT) to develop cost implementation plans for safe CS in their counties. The five facilities per county will be identified with local teams and the Ministry of Health.
Action Plan
This three-year project will start in February 2026, progressively scaling up in each of the counties through a phased approach.
In February 2026, a meeting with government, facility and community partners will launch the project, building on lessons learned in Nakuru County, towards progressive engagement of the three other counties.
In Q1-Q2 2026, a learning agenda for all new counties will be submitted and ethics approval secured, before conducting comprehensive baseline assessments and collecting quantitative and qualitative data to ensure tailored interventions.
In Q3-Q4 2026, facility readiness gaps identified will be addressed, and the Safe CS curriculum will be adapted by local teams. Safe CS clinical skills trainings will be conducted in each county for approximately 25 participants (5 surgical teams) , including future mentors from the hub facility, who will amplify the learning for all staff in each hub and spoke facility. Refresher trainings will be organized once a year during the project. A blended leadership training will be offered to the surgical team members through a Community of Practice (CoP) on the SURGhub app and WhatsApp group.
Starting in Q1 2027, alternating in-person and virtual mentorship sessions will be conducted for all facilities, including through a SURGhub CoP within and across counties as a continuous knowledge sharing and peer support for all disciplines in facilities.
From Q1 2027 to Q1 2029, continuous learning and adaptation will inform programming, including additions of innovative tools for optimizing the impact, as well as stronger engagement of CHPs and maximizing women’s experience of care. In addition, quantitative and qualitative data generated will allow advocacy towards integration of the comprehensive approach at the subnational and national levels. Costing data will help inform county and national strategies for sustainable funding for access to Safe CS in decentralized settings.
Background
Access to emergency obstetric care through caesarean section (CS) , when needed, is critical to save mothers and their newborns. Globally, timely access to safe CS can avert 100,000 maternal deaths every year and reduce perinatal mortality by 30-70% (Meara, et al. 2015) .
Access to CS needs to be safe, timely, and respectful for all pregnant women. Women giving birth in low and middle-income countries (LMICs) are 100 times more likely to die following CS than those in high-income countries. Globally, haemorrhage and infection continue to be the major contributors of maternal morbidity and mortality following CS (Meara, et al. 2015) .
In Kenya, the maternal mortality ratio of 379 per 100,000 live births is far behind the SDG target, and represents only an 11% decrease over the last 20 years (Global MMEIG 2025) . Similarly, the 2023 neonatal mortality rate of 21.5 per 1,000 live births has stagnated in Kenya over the past decade, along with one of the highest stillbirth rates globally at 16.26 per 1,000 total births (UN IGME 2025) .
Quality of care, once pregnant women reach a facility, is a significant concern in Kenya, especially for CS. Most facility-based maternal deaths (71%) are associated with CS, and the lack of quality, standardized clinical care has been identified in 90% of maternal deaths (NIH 2023) .
Challenges regarding access to safe CS are multifactorial and include: lack of training of surgical teams on both technical and non-technical skills (e.g. teamwork and communication) ; not adapting global recommendations for safe CS care to the local context; insufficient facility readiness; poorly functioning referral pathways; poor collection and use of quality data, including costing, to inform prioritization and scale-up (Lancet Commission on Global Surgery 2030) ; and poor follow-up of postpartum women and newborns in the communities (Boatin 2021) .
Progress Update
Partnership Opportunities
GSF is seeking new partners across the maternal and newborn health pathway to introduce and scale-up key interventions across the continuum of care, specifically with innovative approaches and/or digital health technologies. The GSF seeks partnership:
In community health: expertise in facilitating timely access to emergency obstetric care and for strengthening postpartum follow-up of women and newborns after a cesarean section through community health promoters.
In data collection and use: expertise in systematization of data quality, collection and use along the perioperative continuum of care, for example through digital apps.
For post-operative care and monitoring: wearable technologies to overcome human resource challenges and to improve early identification of physiologic deterioration and to prompt action.
Partners working in remote/virtual surgical training and mentoring to facilitate scale-up surgical team capacity building in all settings.
In health economics: expertise in providing costing analysis to inform government investments for sustainability and scaling up.,As the world-leading agency for building surgical care capacity globally, GSF offers partners the following services in surgical care for women:
A global, neutral partnership platform with unparalleled access to the world’s leading organisations in surgical care, as well as diplomatic links to 193 UN member states;
Access to technical expertise leading global and on-the-ground technical and programmatic expertise in safe surgery/safe caesarian section;
Training methodologies with proven approaches to workforce capacity building through team-based training, including technical and non-technical skills;
Data collection and policy know-how, including advanced methodologies and frameworks for adopting global recommendations into the local context;
Access to the online learning platform SURGhub, which is the award-winning global training platform for the surgical care workforce, active in 190+ countries and with over 17,000 registered healthcare workers. SURGfund is the first and only catalytic fund for surgical care systems, enabling coordinated investments for greater impact.