This post was written by Sarah Manyeki, Monitoring & Evaluation Officer for Mothers’ Union Kenya – Anglican Overseas Aid’s partner in The Road Less Travelled project.
In the remote Maasai community of Morupusi, in Kenya’s Laikipia County, the training and deployment of Community Health Workers (CHWs) is beginning to see positive results. Elizabeth Kaparo was trained as a CHW in 2012, an initiative of The Road Less Travelled (TRLT), a project that is committed to improving access to basic health care for nomadic pastoralist communities.
CHWs, people trained in basic health skills and who live within the nomadic pastoralist communities, are part of the Kenyan Ministry of Health’s (MoH) strategy to find local solutions to the barriers to accessing health services. TRLT partner the Mothers’ Union works with the MoH to facilitate the training of CHWs. This collaboration is an important step to bridge the gap between the traditional practices of these communities, and formal health facilities.
The project envisages the CHWs as a vital asset to their community, offering a cost-effective, accessible, and community-owned health resource.
One of the most important elements of Elizabeth’s role as a CHW involves visiting expectant mothers. The antenatal period presents an opportunity to provide pregnant women with interventions that improve their health and wellbeing (and that of their children), and identify risks in the lead up to delivery.
Elizabeth says the CHWs in the area have found it hard to convince pregnant women, especially those in the early stages, to attend the antenatal clinic. “When we approach women, they confront us, asking us who told us that they are pregnant.”
Despite the initial challenge, her visits are showing results. Elizabeth has observed a shift in the perception of pastoralist mothers towards formal health services, with some women starting to attend antenatal check-ups with her encouragement. Veronica, a mother of five, has delivered all of her babies at home without the assistance of a skilled birth attendant. “I never know the date that I am likely to give birth, that is why I end up giving birth alone … this is because apart from the last pregnancy, I have never attended antenatal check-ups.”
Elizabeth visited Veronica in her home once she realised she was expecting, encouraging her to visit the health centre for check-ups and advice. Before she spoke with Elizabeth, Veronica said “I used to fear visiting the facility because there was a rumour that women were mistreated when they visited the health facility…”
“I attended antenatal check-ups for the last pregnancy because I had been sensitised on the importance of the check-ups by the village CHW.”
Reflecting on the experience throughout her pregnancy, Veronica said “the staff at the facility were always good to me … when I went for the check-ups, I was tested and therefore knew my (HIV) status and the baby’s status. I was advised on the right diet, and the baby’s position was checked. I was also immunised against diseases that could harm me and the baby.”
Although Veronica was fortunate to have never experienced any problems during childbirth, she said that the advice given at the facility during the check-ups was very important and useful to her.
When the time came for her to deliver, however, Veronica did not make it to the health facility. “The labour pains came at night and it had rained a lot. I also did not have the means to go to the health facility.” She lives eight kilometres away from the health centre, with poor roads made worse during the rainy season, and no public transport.
She said that despite the fact that she was prepared for the birth – having bought cloths, a new razor blade, clean thread and baby jelly – she didn’t have the money for transport to the facility. “In case of an emergency, one can call the ambulance from the facility which charges a minimum of 2,000 Kenyan shillings (approximately $25 AUD), and the amount increases with distance.” This cost is a major barrier for many pastoralist women, leaving them no option but to deliver at home.
Veronica said if she had the opportunity, she would do things differently. “If I were to give birth again, I would prefer to do it in a health facility, and my advice to other women is for them to attend the clinic.”
Another woman from the Morupusi community is Theresa, mother to a three-month-old baby. She is one of very few women in the area who has given birth in a health facility.
Theresa started attending antenatal check-ups when she was six months pregnant, after receiving a visit from the CHW at home. When asked why she had she delayed starting the check-ups, she said “I was ashamed of people realising that I am pregnant, this being my first pregnancy. I feared walking around, in case I met with my former classmates who were still in school.”
Theresa said that her experience at the health facility was good, despite her initial reservations. She was made aware of the importance of starting the check-ups earlier in her pregnancy. She said that the nurses at the clinic told her how the baby was faring, and they also advised her on her diet.
Other women in her community tried to persuade Theresa to give birth at home, as it is the cultural norm, but she decided she would prefer to give birth in the health facility. She explained that “in the hospital, one does not stay for long with pain (because one can be induced), the hospital is clean, and the nurses put on gloves – unlike at home, where every woman wants to assist you and sometimes they are dirty (their hands are dirty) and could make you have an infection. In the hospital also, one is ‘sewn’ but there is nothing like that at home.”
Theresa said she was lucky she knew a person with a car, who was willing to take her to the health facility at the onset of her labour pains. “Sometimes car owners make it very expensive for women going to give birth in the facility … because they know the women do not have a choice and they fear that the women will give birth inside the car.” The person who took her did not charge her since he was a family friend, but under normal circumstances she would have paid a minimum of 3,000 Kenyan shillings (approximately $38 AUD) for transport.
If she were to give birth again, Theresa said she would prefer to do it in a health facility. When asked what advice she could offer other expectant mothers in her community, she said: “I would advise other women to give birth in hospital, because they have an opportunity to be tested, advised on the right diets, advised on how to prevent the communicable diseases, and also on which chores to do and which ones to avoid (during pregnancy and post-delivery).”
While there are still considerable barriers to safe motherhood for nomadic pastoralist women, and health education is a gradual process, the efforts of Elizabeth and other CHWs trained by the project are starting to take effect. In addition to increasing the number of mothers accessing antenatal care, at least three pastoralist women have now given birth safely in health facilities, supported by skilled birth attendants. The Mothers’ Union is finalising an agreement with the MoH for the distribution of safe birthing kits, which will help women in labour whether they are able to reach a clinic or have to birth at home. These activities might seem small but they are important positive steps on the road to safer birthing practices.