WUNRN
Kenya - Safe Motherhood Vouchers for Medical Care, Reduced
Mortality
By Joyce Mulama
KISUMU, Jun 12 (IPS) - At the age of 14, Zulekha Mumma
delivered her first child. At 21, the birth of her seventh child killed her.
She died from excessive bleeding in her home in Nyalenda, a slum on the
outskirts of Kisumu city in western Kenya, some 400 kilometres from Nairobi.
"It was too late for me to get her to hospital. By the
time I realised her condition was serious, blood was flowing from her body like
a tap and she took in her last breath," Mama Apondi, a traditional birth
attendant who was helping Mumma to deliver, told IPS, still distraught at the
memory of Mumma’s death two years ago.
Not one of Mumma’s children was delivered in hospital where
there is skilled health care, a familiar situation in Kenya where only 40
percent of deliveries take place in hospitals.
The rest give birth at home with the help of birth
attendants who are not equipped to deal with complications from pregnancies,
contributing to high maternal mortality rates. Official figures indicate that
maternal mortality stands at 414 deaths per 100,000 live births.
Two thirds of these deaths are due to postpartum haemorrhage
(severe loss of blood during pregnancy or labour), sepsis (bacterial
infection), eclampsia (severe hypertension in pregnancy) or a ruptured uterus,
which birth attendants like Apondi can neither predict nor deal with.
The cost of delivering a baby in a government hospital
ranges from 20 to 65 dollars. This prompts many poor women to seek the services
of traditional birth attendants, who will charge around 13 dollars. They may
also accept payment in the form of an animal such as a goat for delivering a
baby.
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The
Reproductive Health – Output Based Approach (OBA) programme is an attempt to
overcome maternal deaths by making hospital births affordable.
Initiated in June 2008, the project allows poor women to purchase a safe
motherhood voucher for 200 shillings - equivalent to
about $2.50 – which entitles them to give birth and access ante- and post-natal
care at accredited clinics.
The project was piloted in five areas including Kisumu, Kiambu and Kitui, in
western, central and eastern Kenya respectively, and in Korogocho and Viwandani
slums in Nairobi. Its first phase, which ended October 2008, recorded a massive
turnover of pregnant women seeking skilled care.
Francis Kundu, programme officer of the National Coordinating Agency for
Population and Development, which is overseeing the overall implementation of
the project, said accredited facilities saw a 20 percent increase in the number
of women seeking professional care during pregnancy.
At the Marie Stopes Clinic in Kisumu, one of the accredited health points, the
number of deliveries jumped from less than 50 a month to 150 with the onset of
the voucher system. The private clinic – part of the international family
planning non-profit organisation - had to employ new staff and construct a new
ward to cope with the influx of patients.
"We saw women coming from far and wide; from the remotest of villages in
Kisumu. Some had never set foot in a hospital before," Dr Charles Ochieng'
told IPS.
"The vouchers dignified the poor. The women came to the clinic, some even
barefoot, and they would tell us, ‘We have never felt like this before, so this
is what means to come to a hospital?" said Ochieng’.
Thanks to a voucher, Gladys Owino was able to deliver her fourth child in July
last year at the New Nyanza Provincial General Hospital in Kisumu.
"I was so overjoyed that I could access maternity and post-natal services
at such a big hospital, and be treated by skilled caregivers. My previous
births were conducted by a traditional midwife, and one was so complicated that
I almost lost my life," she said.
A natural childbirth at the Marie Stopes clinic costs 100 dollars; a caesarean
section costs $455. The cost of delivering at the government's hospitals ranges
from 20 to 65 dollars for natural birth and caesarean section respectively.
Poverty - 46 percent of Kenyans are classed as poor - has been the main reason
why women like Owino have earlier failed to turn up even at cheaper government
facilities.
Other reasons for low turn out have included poor quality of service including
claims of aggressive attitudes towards patients by health workers, particularly
at public facilities.
The voucher system is transforming this as well given that it is based on
reimbursement – the more clients a facility gets, the more money it brings in.
Public health staff have been motivated to change their attitudes in order to
bring in more money to improve services.
At the end of the month, each accredited service provider is submits claims for
services rendered, which are then processed and reimbursed by
PriceWaterhouseCoopers, the voucher management agency.
This has resulted in increased competition between public and private health
facilities.
"It has called for improved services and increased standards of health
care delivery. If you have no quality you do not get clients,"Kigen
Bartilol, deputy head of the Division for Reproductive Health under the Family
Health Department within the Ministry of Public Health and Sanitation told IPS.
"Most facilities have been forced to change their attitudes to win
clients. If you do not change, you do not get clients and therefore you do not
get paid.
"There was so much success, particularly with clients seeking safe
motherhood services. Because of the competition, public hospitals improved
services and recorded increased figures in the number of pregnant women seeking
hospital deliveries as well as post natal services," he noted.
Phase two of the project, which will roll the voucher programme out to other
parts of the country, is scheduled to commence in July. However, concerns are
emerging about how the Kenyan authorities will sustain it, should the German
government, which has contributed most of the funding, pull out.
The pilot project was undertaken at a total cost of about 9.2 million dollars.
According to Josephine Kibaru, head of the Family Health Department, the
government is currently in the process of undertaking a study to ascertain how
much nationwide coverage will cost.
"We had asked for Ksh 100 million (about 1.3 million dollars) for the
scheme, and should we not be given the whole amount, then whatever is allocated
can be increased over time," Kibaru observed.
There was increased funding for health in Kenya's latest budget, read on Jun.
11, but at the time of publication, officials were still waiting for a
breakdown of how the money would be spent to be certain the voucher programme's
future is secure.
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