Reasons for Non Improvement of MNH Indicators in Kenya
The main reasons for the non improvement of MNH include: low BOEC coverage, poor access to skilled attendance along the continuum of care, lack of community involvement in MNH, high unmet need for family planning and the delays in seeking appropriate skilled care.
The first delay entails a delay in decision making at household level hence the
importance of community awareness and participation in MNH programmes. In Kenya, many of these deliveries take place in the villages as a result of ignorance - poor knowledge of danger signs, cultural issues, and poor status of women. Women are not empowered to make decisions on skilled birth attendance, and majority of men still control use of resources at household level.
The second delay involves a delay in moving the woman to hospital. Some women may be willing to go to health facilities, but are not able to go due to various barriers.
These include: cost - the cost of maternal care services remains very high for most women in Kenya; access - health facilities are few and sparsely located; the poor state of Kenyan roads and unavailability of transport in many areas makes it hard for many women to access health services at time of need; and poor status of women - most women are not empowered to make decisions on health care due to low education and low socio-economic status.
In the third delay, there is delayed intervention at the facility. This normally arises as a result of poor infrastructure, lack of equipment, and lack of knowledge and skills in EmONC. Poor distribution of health workers has left rural facilities with few or no health workers to provide services. Unfriendly attitude by health workers has also been shown to lower utilization of maternal and newborn Health services.
Women, infants and children living urban slums face serious sexual and reproductive health and rights (SRHR) challenges. Slums are urban settlements of makeshift housing with little to no effective infrastructure, often found on the outskirts of major cities. Since slums are unplanned, they usually have no basic services such as running water, sanitation, electricity or street lighting, garbage disposal, or healthcare and family planning. They are normally characterised by extremely high density living and overcrowding, with high levels of water-borne disease and pollution, including air pollution due to the burning of rubbish. Slums are inhabited by the poorest who cannot afford more permanent housing, and who therefore face further hardships due to social, economic and physical marginalisation, insecurity, and the deterioration and even reversal of key health indicators.
Life in urban slums, including the Landmawe and Viwandani slums in Nairobi, Kenya, are linked to adverse SHRH outcomes including higher rates of fertility, unplanned pregnancies, sexually transmitted infections (STIs), sexual and gender-based violence, as well as pregnancy related morbidity and mortality. This project aims to better the living environment of vulnerable women, infants and children living in Nairobi’s informal settlements, taking a pre-emptive and preventative approach to reducing the incidence of poor SRHR outcomes. It will do so by advocating for, and implementing appropriate waste management, thus decreasing risk of poor health outcomes, including from water-borne and respiratory infections. The project will provide waste collection services, and instigate educational activities to increase awareness regarding the importance of healthy waste disposal and sanitation through workshops, seminars and door-to-door advertising. Furthermore, the project will provide a basic primary health service package for affected women and children in the slums, including antenatal and postnatal check-ups, diagnostic testing and treatment of infections, and counselling services.
The project aims to improve equity and accessibility to improved health for the most vulnerable populations in Nairobi, taking a preventative approach that does not rely on existing health systems and structures. It envisions a community-wide approach, and one that could eventually be expanded to informal settlements in other parts of the country and beyond. It will work to address the Sustainable Development Goal 3 to promote healthy lives and wellbeing for all at all ages, and the Sustainable Development Goal 5 to achieve gender equality, empower all women and girls and ensure access to SRHR.