Using Community Linkages to Increase Uptake of Services for Mothers and Children in Kwale County

Fatuma enjoys visiting households to identify pregnant women, provide health education and screen for health conditions that require a referral to a higher level of care. However, today she is following up on a client and is not her usual bubbly self. The client she is visiting is 26 weeks pregnant and has missed two of her scheduled antenatal clinic (ANC) appointments at the nearest Kikoneni Health Center in Kwale County. This will affect Fatuma’s performance during the monthly meetings with her fellow community health volunteers (CHVs) and the Kikoneni H.C facility management team.

“The challenge is that most pregnant women do not seek antenatal care until they are ready to deliver; and most believe that some signs like headaches, dizziness, bleeding and fatigue are normal signs of pregnancy. On the contrary, these are some of the danger signs!” explains Fatuma.

In Kenya, almost all women (96%) attend their first ANC and 56% receive at least 4 ANC contacts with a health care provider. However, in Kwale County, the proportion of women attending the first ANC visit and those attending at least 4 ANC visits is 98% and 50% respectively. This has greatly affected WHO’s recommendation for women to visit a health facility after 2 consecutive missed periods to confirm pregnancy. Early attendance of antenatal care services, before 13 weeks of pregnancy, which marks the end of the first part (trimester) of pregnancy also ensures that mothers receive critical health promotion and disease prevention services like HIV screening and vitamin supplementation.

To increase antenatal visits and reduce maternal deaths the USAID Stawisha Pwani project is empowering women and children through strengthening linkages between the health facility and CHVs who conduct home visits, identify pregnant mothers and refer them for services. The five-day training on defaulter tracing covered sessions such as; the importance of ANC defaulter tracing in improving pregnancy outcomes; the USAID Stawisha Pwani approach on ANC defaulter tracing and documentation of the intervention in the reporting tools namely the appointment diary, defaulter tracing register and how these tools can be used alongside the facility ANC register and

CHV’s referral booklet in the ANC defaulter process. Since the training was done in December 2021, the number of women attending the first ANC has increased by 49 per cent while the fourth ANC visits at Kikoneni H.C increased by 144%.

Grace Syuki the Kikoneni H.C facility in-charge attributes this increase to the training on defaulter tracing that has helped them to establish well-coordinated efforts between the health facility management team (CHMT) and the CHVs linked to the facility to follow up on mothers and children who default from routine health services. “After the training, we were able to develop a flow chart that guides the team on defaulter tracing and a map of the villages linked to the health facility. We use coloured pins to identify the areas that have defaulters of antenatal care and immunization services”.

“It is discouraging when we go for monthly meetings and your village has the most pins on the map, it gives the perception that you have not been working, but when there are no pins we are rewarded,” says Fatuma.

“Monthly meetings have become interactive because we use the data in the defaulters register to identify which villages have defaulters and their corresponding CHVs. No CHV wants to come to a meeting where they are informed that their village has many pins (defaulters) on the map” notes Grace.

According to Felix Makasanda the USAID Stawisha Pwani project gender-based violence (GBV) technical officer, “the project has prioritized increasing coverage for antenatal care and skilled birth attendance through the ANC defaulter tracing to help reduce maternal and child mortalities in the County”. So far 1, 031 CHVs drawn from one hundred health facilities across Kwale County have been trained on maternal and newborn health modules.