CURBING MATERNAL DEATHS AT THE CLICK OF A BUTTON

Ms Mary Wanjiku, a community health worker at Kiababu village in Githunguri, Kiambu, with Ms Pauline Wanjira, a new mother, at her home. The health workers here use a mobile phone application to ensure that expectant mothers honour their clinic visits. PHOTO| ERIC WAINAINA

By ERIC WAINAINA

While maternal deaths have reduced significantly since the introduction of free maternity services and the Beyond Zero campaign, still, there is death.

A number of maternal and infant deaths are still being recorded in some parts of the country, due to ignorance of antenatal and prenatal care.

This has been attributed to the government’s inability to track and follow up on expectant mothers to ensure maximum maternal care adherence.

For a village in Githunguri, Kiambu County, such deaths are unheard of though. Here, expectant mothers and children under the age of five are monitored closely to ensure that they get the required medical care. This is done through a mobile phone application.

The programme, initiated through the support of the National Council of Churches of Kenya (NCCK), and an international development charity, Christian Aid, ensures that all mothers in Kiaibabu village go through the full maternal care cycle, from pregnancy to when their children turn five.

The mobile phone application enhances tracking and follow-up on the expectant mothers and children and guarantees total adherence. The initiative has seen the sleepy village receive delegates from various countries to learn about the system.

Known as Kujua programme, it is managed by local volunteers, commonly referred to as Community Health Workers (CHWs).

Twenty five volunteers were trained by NCCK and Christian Aid through a government policy, community strategy. They were equipped with skills to manage the programme as well as basic knowledge on maternal care.

HEALTH CHECKS

The volunteers are in charge of selected households in their neighbourhoods, whereby they are expected to identify all expectant women and all homes with children under  five years, and then ensure that they go through all the necessary health checks.

For instance, Ms Mary Wanjiku, who is also  the CHWs secretary, manages 198 households at Kamondo sub-village. She and her colleagues work closely with local doctors and nurses to enhance their campaign.

“There are 25 CHWs deployed across the village, which has about 15, 000 people,” says Ms Wanjiku.

Once they identify an expectant woman, the CHWs, who are given exclusive rights to make use of the system by having their mobile phone numbers connected to it, register the women by sending their names and pregnancy stages via an SMS though a specific code number.

The registration is confirmed through a reply text message that sets a unique code for each woman, which then serves as her exclusive information account.

APPOINTMENT DATES

The confirmation message also gives the dates she is supposed to attend clinic depending on her pregnancy stage and status.

This way, the CHWs receive constant reminders for each woman depending on her clinic appointment dates.

For instance, if an expectant woman has an appointment in three weeks’ time, the application sends a reminder to the CHWs, asking them to remind the expectant mother about her clinic appointment.

One week to the appointment date, a second reminder is sent and a third one two days to the actual date. On the appointment day, the application sends another message, this time asking a community health worker to confirm whether the mother honoured the appointment.

“I visit the woman at home and check her card to confirm whether she honoured the appointment, and if she did, I update the system by sending a message in which I give information about the progress, including whether there are any complications. If she did not, I will ensure she visits the clinic immediately,” Ms Wanjiku explains.

If there are any complications, the volunteers receive directions which include referral suggestion, which they share with the mother.

“The system ensures that any woman who is registered in the programme attends clinic on time and always,” Ms Wanjiku says, adding that for women who do not own phones, the volunteers visit their homes or use other means to ensure that the message reaches them.

Ms Pauline Wanjira, 23, a mother of a four months old, is among the more than 100 mothers who have been under Wanjiku’s watch. The new mother, who was put under the programme when she was six months pregnant, says it has served her well. She admits that at times she would forget about the clinic appointment dates, thus the initiative comes in handy.

“The reminders ensured that I honoured all my appointments, and after delivery, Wanjiku is still in touch, and ensures that my son gets all the immunisations.”

Ms Grace Njoki, a CHW in charge of Gituamba sub-village, explains that after one delivers, the volunteers send an update regarding the status of the newborn before deregistering the mother. They also register the child using the mother’s mobile number,  enabling them to keep track on postnatal care for the infant until he or she is five.

The follow-up includes ensuring the new born gets all the immunisations and other health requirements without fail.

“Since we started the programme in 2012, no expectant woman in the area that I represent has ever failed to adhere to the prenatal care or delivered at home like was common before,” says Njoki, who manages 21 households.

All the 25 CHWs, some of them men, have the basic knowledge about what a healthy pregnancy constitutes, labour and delivery.

Dr Ruth Wangui, who is in charge of the local Kiaibabu Health Centre, where the CHWs refer expectant women, says they have been working closely with the community health workers  and from the hospital records, the number of mothers seeking maternal care at the facility has shot up.

The health facility, which still remains ill-equipped, according to the locals, was constructed through the Githunguri Constituency Development Fund.  

The programme, says Dr Wangui, has seen an almost 100 per cent adherence. She notes that despite the fact that the facility  is in a small village setup, it sometimes records  two deliveries a day.

“Before, we had many cases where expectant women, especially those who work in the tea and coffee estates, would never go to hospital throughout the pregnancy, and even delivered in their homes - with the programme though, this is no longer the case.”

Every month, the community health workers who recently registered themselves as a community based organisation (Kiaibabu Community Health Unit), hold a meeting to update each other and strategise on how to seal any gaps, the aim to improve their performance.

MALE ATTENDANT

They say the mobile phone application, which has been in use since 2014, has made their work easier. Before, they would identify an expectant mother and then register her in a file, which they had to constantly go through. They would then call the mother or visit her homes to remind her of her appointment dates.

Mr Joseph Kamukwa, one of the few male CHWs in the group, says the process was tedious and time consuming, but the mobile phone system has enhanced communication and timeliness.

“Today, I do very little because the system sorts the dates and sends the reminders to me. Mine is just to do a follow-up to ensure the woman attends clinics on the right date,” says Kamukwa, who is in charge of 25 households at Kamondo village.

But how do they identify the expectant mothers and ensure they are registered? Each CHW is deployed in an area where he or she is familiar with everybody, so it is easy to keep tabs on everyone.

“Since I know all the people under the households in my area because that’s where I live, my work is easy. If I notice a woman is pregnant, I will approach her, explain what I do and why it is necessary, and then register her,” says Wanjiku, adding that they are also tipped by those who know the woman.

Tabitha Wairimu, the NCCK Githunguri constituency organiser, says the programme was initiated after a social audit on health in 2011, which exposed numerous gaps in maternal health care in the area.

“There were very many cases of mother and child deaths, and other maternal-related complications such a fistula, due to lack of awareness by the community as well as lack of health facilities,” she says.

After the audit, they identified the community health workers. A meeting was then held, after which the volunteers were trained and deployed.

By then, Kiaibabu Health Centre was a dispensary, thus the CHWs would refer the expectant mothers to Githiga, Githunguri and Kiambu hospitals, which are nine, 10 and 15 kilometres away, respectively.

“There was therefore a need to have a maternity facility around, and so NCCK and Christian Aid put up a maternity wing within the facility, which was then elevated to a health centre.”

The facility was officially opened by NCCK Secretary General, Rev Peter Karanja in July 2014.

 The use of the mobile phone application came later, when a review of the programme revealed that though the programme was recording positive results, it was not efficient.

“This is how the idea of using a mobile application to monitor the women and children came about.”

Though efficient, the system has not been  without challenges, one of them being that at the moment, the health workers use their own resources to run and manage it.

Another challenge is that in most cases, the reception they get is hostile, especially because they do not have identification that matches what they do.

“Some think we are impostors because we have no accreditation. In other cases, our male colleagues are accused of having ulterior motives by the women’s husbands,” explains Ms Wairimu, adding that they do not get any recognition from the government.

And yet theirs is an important job which has probably saved numerous lives.

Instead of accepting all depositors, however small, banks only sucked up to paper pushers in formal employment who had salaries that could be channelled through them.”

SOURCE: NATION