May 14
May 14, 2013

Transforming Maternal Health in Western Kenya


This past Sunday, mothers in the U.S. were honored by their loved ones for their generosity and often self-sacrificing kindness. Defined differently by cultures and communities the world over, motherhood is a unique experience capable of altering the life of a woman permanently. Unfortunately for some, this process of becoming a mother can be very challenging—and sometimes life-threatening. In some regions of the world, high numbers of women face complications during pregnancy that put both their lives and the lives of their babies at risk. In Kenya in 2009, for instance, 560 women died during pregnancy and childbirth for every 100,000 live births, and maternal deaths accounted for 15 percent of all female deaths. During this time, Kenya’s Ministry of Health reported that more than 500,000 women suffered physical injuries during pregnancy or childbirth, and as many as 194,000 of these injuries may have been life-threatening.

Committing to Make a Change
To address this serious situation in Kenya, the Lwala Community Alliance made a 2009 CGI Commitment to Action to enhance the quality and extend the reach of maternal and child health services in North Kamagambo, Kenya. North Kamagambo is located within the Rongo District of Nyanza Province, where an estimated 95 infants died per 1,000 live births in 2009. Women of the Rongo District face many risk factors for maternal morbidity and mortality, including early marriage, low contraceptive prevalence, a high total fertility rate, and gender disparities in education, economic independence, and decision-making power. In addition, teen pregnancy rates are high and young teenage mothers are not sufficiently informed about safe motherhood practices.

In 2009, when the Lwala Community Alliance made their commitment, the Lwala Community Health Center was experiencing a high demand for emergency obstetric care, despite its lack of a dedicated maternity wing. Since the facility’s opening in April of 2007, women with birthing complications had been making frequent visits to the center, which was not adequately equipped to provide safe maternity care. To develop this capacity, Lwala’s commitment involved two major elements: First, build a dedicated maternity wing capable of treating and caring for these women and second, conduct community health outreach that fosters the creation of future community leaders who are educated about safe motherhood practices.

Building Capacity and Community Awareness
As of today, this commitment’s dual approach of infrastructure development and robust community outreach and education has achieved remarkable results. The Lwala Community Alliance completed the construction of a new maternity wing for the Health Center in 2011, with dedicated space for labor, delivery, and postnatal care. This expansion tripled the size of the health facility and helped reclassify it as a sub-district hospital, now named the Lwala Community Hospital.

Additionally, in 2012 Lwala launched a community health effort to recruit and enroll all local pregnant women in the entire continuum of maternal, neonatal, and child health care. Using a curriculum developed by USAID that focuses on safe motherhood and water sanitation and hygiene, Lwala trained a cadre of Community Health Workers (CHWs) and Community Health Promoters (CHPs), 40 percent of whom are former traditional birth attendants. The CHWs and CHPs work together in teams to provide comprehensive care to pregnant women in 10 specific geographic precincts. The CHWs are tasked with making regular home visits to pregnant women, enrolling them in care, providing health education to the women and their families, and meeting with Lwala staff on a regular basis. The CHPs identify pregnant women and accompany them for their prenatal care, delivery, and postnatal care visits at the facility. In addition, they work to provide psychosocial support during these appointments. This community outreach has lead to an increased demand for prenatal and postnatal care, facility-based delivery, and childhood immunizations throughout the area.

The Success of Peer-to-Peer Engagement
The CHWs and CHPs come from a similar background as the pregnant women they are working with, possessing the same education level or less and often residing just down the road from the mother-to-be. These similarities make them uniquely positioned to make impactful, personal connections with the pregnant women. Through this model, Lwala has observed the power of positive peer pressure from these "big sisters," making the women more likely to access and inquire about pre and postnatal services and increasing the effectiveness of the care.

Lillian Anyango, a community member who recently delivered twins at the Lwala Community Hospital (pictured below), described her experience with the CHWs, “The Community Health Workers have been very friendly, loving, and caring to me and are also committed to their work. Even after I had given birth, they still kept visiting me to check on how me and my babies were doing."

Transforming Maternal Health for Future Generations
Prior to the Lwala Community Alliance’s commitment efforts, only 26 percent of pregnant women in North Kamagambo were delivering with a nurse in the safety of a facility. Since the successful enactment of this work, 95 percent of pregnant women are now delivering with a nurse in a health facility and antenatal care completion rates have risen from 34 percent to above 60 percent. Furthermore, there has been a 58 percent increase in the number of well-child visits conducted and a more than 100 percent increase in the number of monthly patient visits at the Lwala Community Hospital.

Through this commitment, Lwala and its fellow CGI member partners—including Ronald McDonald House Charities, the Segal Family Foundation, BD, and Riders for Health—are saving the lives of both infants and mothers throughout North Kamagambo. With support, this successful model of health care and education can be taken to other areas in Kenya that face similar maternal health challenges.

To find out more about this commitment, click here.

All photos in this post are credit to Lwala Community Alliance: Safe Motherhood in Lwala, Kenya / Clinton Global Initiative