LITMUS TEST OF TURKANA HEALTH SYSTEM: County Health Directorate Presents the First MPDSR Report

There is a global consensus that accurate information about the causes of maternal and newborn deaths through mortality audits is necessary to inform efforts towards ending maternal and perinatal deaths. According to the Kenya Demographic Health Survey 2014, Turkana County was ranked the third-highest burden county in maternal mortality experiencing 1,594 maternal deaths/100,000 live births against the national average of 362 deaths/100,000 live births.

The data further revealed that among the direct causes of maternal deaths, 50% were caused by postpartum haemorrhage, 25 % were due to infections, 13 % due to Eclampsia, while 6% were caused by obstructed labour. These lives would have been saved through access to quality and affordable family planning, antenatal care, skilled delivery and postnatal care services.

Scaling up Maternal and Perinatal Death Surveillance and Response (MPDSR) at County Level

The inception of devolution registered increased resource allocation and management of local governance structures and local level authority in decision making. Borrowing heavily from the Kenya Maternal and Perinatal Death Surveillance and Response (MPDSR) 2016 Guidelines, the USAID funded Afya Timiza project adopted a structured multi-sector response to strengthen sub-national/County MPDSR systems by facilitating the bi-annual MPDSR feedback fora between the Turkana County Assembly Committee for Health and the County Department of Health (CDoH). The fora aimed to alleviate maternal and child mortality. To support this, the project has been providing technical support to strengthen health systems including the training of county and sub-county health management teams on leadership, management and governance, mentorship of health facility workers on basic emergency neonatal and obstetric care, kangaroo mother care; advocacy through the establishment of MPDSR committees, enactment of the Community Health Workers bill 2018 and drafting of the gender policy.

This was evident through the inaugural MPDSR updates report that was presented to the Turkana County Assembly Committee for Health on September 10, 2020; 20 women in Turkana County died from pregnancy-related complications out of 797 maternal complications reported in the county during the last financial year (June 2019 – July 2020). Further analysis of the data indicated that 7 (35%) died from Eclampsia, 2 (10%) died from obstructed labour, 2 (10%) died from postpartum haemorrhage, 2 (10%) died from ruptured uterus, and 7 (35%) died from other complications; all preventable deaths.

Increasing Investments in Health

Speaking during the MPDSR updates meeting, Dr Roberts Abok – Turkana County Chief Officer for Health called for the allocation of more resources by the county government to operationalise theatres across all sub-counties to address emergencies. Dr Abok opined that the members of the County Assembly Committee for Health should also advocate for increased budgets and employment of health workers, efficient water and electricity supply to all health facilities in the county. He emphasised that Afya Timiza has implemented high impact interventions such as the training of health facility workers on the use of RMNCAH scorecards and dashboards, the traditional birthing cushion which allows mothers to deliver in their culturally acceptable position of squatting; capacity building of community health workers and traditional birth companions; and demand creation through collaboration with traditional leadership structures which could be scaled up within minimum budgets.

Next Steps

Some of the reflections from the meeting included continued collaboration between partners and the County Department of Health to operationalise the draft Turkana County Referral Strategy towards strengthening county MPDSR systems. Specific actions presented include:

· Procurement of 11 ambulances to support the timely referral of mothers from lower-level health facilities;

· Establishing an efficient supply chain system to ensure the availability of essential medicines and medical supplies;

· A multi-sector approach towards MPDSR in collaboration with the national Reproductive and Maternal Health Services Unit;

· Advocacy for more funds to support the implementation of the community health strategy, public health and for verbal autopsy forums at the community level; strengthen lab systems for reliable blood safety and supply amidst the COVID-19 pandemic, funding for blood donation drives;

· Increased support for basic maternal obstetric and newborn care training and initiation of targeted interventions to address the underlying causes of maternal and neonatal deaths;

· Upgrading at least all Sub-County Health Facilities to be Comprehensive Emergency Obstetric and Newborn Care sites for easy referral;

· Prioritise fully operationalising health facilities rather than setting up new ones;

· An agile oversight role by the County Assembly and an accountable CDoH;

· Meet priorities factored in the Turkana County Annual Workplan;

· Review of the Turkana County Health Services Administration Bill and the Family planning Costed Plan.

Mr Lochor Kongobin, the County Assembly majority leader and speaking on behalf of the chairman of the County Assembly Committee for Health, reiterated that the assembly would continue advocacy for increased allocation of funds with concerted efforts towards ending preventable maternal and child deaths. Some of the committee members who also sit in the County Budget and Appropriations Committee committed to pushing for the health budget ceiling to the set standard of 15% as enshrined in the Abuja declaration. The USAID Afya Timiza project will continue to support this vital bi-annual forum to enhance evidence-based advocacy, policy, planning, service delivery and accountability for accelerating progress.

Afya Timiza is a USAID funded program aimed at sustainably improving health outcomes for women, girls, children and adolescents in the hard to reach areas of Samburu and Turkana Counties. The project has so far supported the establishment of 16 MPDSR committees and trained staff in over 150 health facilities in both counties on the same towards saving the lives of women and children.

(Photo caption) Members of the Turkana County Assembly Committee for Health and County Department of Health pose for a Photo during an MPDSR Review and Feedback Meeting in Lodwar