- To get a clearer picture, let us look at the 2016 figures captured by DHIS2, which indicate that 964 women died in childbirth last year.
- If, as the source indicated, this represents 10 per cent of maternal deaths, then extrapolating it to 100 per cent means the actual figure is 9,640, which translates to about 26 maternal deaths daily.
An accident that kills 20 passengers in the country hits the headlines instantly and remains in the news for days.
Yet nearly an equal number of women die in childbirth every day but do not receive as much attention, medical experts note.
Worse still, this happens when the healthcare system is working at optimum level.
A confidential Ministry of Health report derived from the District Health Information Systems (DHIS2) shows that 857 women died in childbirth in the first half of this year, up from 413 for the equivalent period last year.
Yet the ministry captures only 10 per cent of maternal deaths since many more go unrecorded. Last month the Business Daily reported that the ministry was able to capture only 10 per cent of maternal deaths because more than 50 per cent of the public health facilities remained closed during the nearly five-month nurses strike that ended early this month.
However, a senior official in the Ministry of Health who sought anonymity for fear of being victimised told DN2 that the 10 per cent applies not just to the period of the strike, but is what the government has been able to track all along.
A 2004 gazette notice by the health ministry made it mandatory for chiefs and local medical officers of health to report maternal deaths that occurred in the community and at medical facilities respectively within 24 hours.
But does this mean that even with the notice the health ministry still cannot track all maternal deaths?
“It can track them. The infrastructure is there. The problem is at the health facilities and at the community level. There are many taboos related to reporting a woman’s death. And because of cultural beliefs, many people don’t report a maternal death. Yet as a health worker, if you report a maternal death, you get into trouble (they have in the past been accused of negligence by both the community and regulatory bodies such as the nursing council, which can lead to prosecution), so medical officers report such deaths as having been caused by something different,” says the source.
To get a clearer picture, let us look at the 2016 figures captured by DHIS2, which indicate that 964 women died in childbirth last year.
If, as the source indicated, this represents 10 per cent of maternal deaths, then extrapolating it to 100 per cent means the actual figure is 9,640, which translates to about 26 maternal deaths daily.
Soon after doctors resumed duty after a three-month strike, nurses and other health workers started a series of work boycotts, until nurses allied to the Kenya National Union of Nurses (KNUN) finally downed their tools on June 5, demanding a Sh25,000 monthly allowance, Sh15,400 risk compensation, and other allowances.
The number of mothers dying from complications during childbirth doubled. Besides, the country is staring at a coming disease crisis since children were not vaccinated, and diseases that had been brought under control are re-emerging, reversing the gains the country has made over the years.
To better understand the impact of the nurses’ strike on maternal and child health, it is important to look at the role they play in these areas.
“When it comes to maternal and child health, the nursing fraternity is indispensible,” says Dr Kimani Ngaruiya, a paediatrician and the director of clinical services at St Mary’s Mission Hospital in Langata. He lends credence to KNUN Secretary-General Seth Panyako’s assertion that nurses manage 99 per cent of the childbearing process, from conception to post-delivery.
Perhaps the biggest and most crucial role nurses play in any health facility is managing maternal healthcare.
“In all government facilities and even private, faith-based facilities like St Mary’s Hospital, it is the nurses who run the antenatal clinics, where women are followed up once they are pregnant,” says Dr Ngaruiya.
He adds that as part of their sub-speciality, nurses are trained as midwives: “This implies that they are the ones who handle normal deliveries, which are usually the majority because labour is a natural process.”
Notably, the 2014 Kenya Demographic Health Survey (KDHS), which sampled 31,079 women between the ages of 15 and 49, showed the 96 per cent of those who had had a live birth in the previous five years had been given antenatal care by a skilled provider (doctor, nurse or midwife).
Statistics from Pumwani Maternity Hospital indicate that on average, 500 women attend ante-natal clinics every month. When the nurses strike began in June, the number dropped to 178.
However, it gradually rose to 239 in July and to 296 in August respectively, reaching 360 in September, which is attributed to the arrival of a new group of nurses at the facility that month.
“We have never closed this facility. Mothers just stayed away, probably thinking that we were also on strike. Most of our nurses are not members of the KNUN which called the strike,” says Dr Catherine Mutinda, head of clinical services at Pumwani Maternity Hospital.
The figures from Pumwani stand in sharp contrast to those recorded at St Mary’s Hospital. While on average 3,500 mothers have been attending ante-natal clinic at the hospital every month, these figures stood at 3,859 in June, 3,965 in July, fell to 3,571 in August and then rose again to 3,999 in September.
Another important role nurses play is monitoring patients and implementing doctor’s orders.