MAMA Kits for Expectant Mothers, Baringo, Kenya

INTRODUCTION What is a mama kit? A Mama Kit is a set of materials Hifadhi Africa donate to expectant mothers in rural Kenya to be utilized by traditional birth attendants (TBAs) during delivery process to help provide clean and safe delivery. Women who do not afford to pay for maternity fees in local dispensaries and medical clinics expressed to HAO that they were turned away and/or opted to seek services of traditional birth attendants at home. There alarming cases of birth complications and death during home deliveries. The support from HAO encourage expectant women to seek prenatal check-ups from local health centers or traditional birth attendants during the course of their pregnancy before receiving the kits. This progressively reduce the number of women and babies dying during childbirth. There are two types of Mama Kits donated by HAO. Each kit is $25 and is assembled in-country. 1. Mama Kit - Birthing Supplies Plastic sheets to keep the area clean and sterile Surgical gloves for the midwife Cotton, gauze A cord band ligature and sterile razor blade for tying off the umbilical cord A child health and immunization card to encourage the mom to get the child vaccinated 2. Mama Kit - Layette Baby blankets Baby hats, socks, and gloves Baby Onesies and warm clothing Mosquito net (to protect against malaria) Baby soap and oil Diaper bag Mama Kits Distribution HAO recently received Toyota Hilux Double Cabin donation from MIVA Switzerland to help facilitate outreach activities and support distribution of critical products and services like Mama Kits. The HAO teams visit communities and identify pregnant mothers, verify and sensitize them about the kit on the day of distribution. While the TBAs attend the sensitization, they don't keep the kits. The kits are given directly to the beneficiaries - the expectant mothers. During the sensitization they encourage expectant mothers to attend antenatal clinics (ANCs). HAO also work with health clinics, and community-based health organizations in East Pokot that distribute the kits for us. The Pokot Woman without Mama Kit Cheptanu, an expectant Pokot woman who interacted with HAO field staff shade light on the fate pregnant women from resource-deprived communities like Pokot undergo when seeking antenatal care services. I would rather give birth at home to avoid the harassment and embarrassment. My husband does not see the need to pay for maternity services nor for me to deliver at a health center. He says it is expensive for nothing. Local nurses also are rude, unsupportive and wear don't care faces unless you have money. They know women like me come to deliver for free. 'Why would you have children if you can't afford baby wrappers?' they would tell us. I personally prefer traditional birth attendants. Maternity services at Kenyan health centers are among the most expensive costs in the country. This hinder pregnant women from delivering at health facilities. Mama Kit provides the most essential items that often inflate maternity costs. Mama Kits also ensure safe deliveries for those who chose to be attended by TBAs. The State Department for Medical Services and Baringo County Department of Health Services acknowledge the importance of ensuring that every expectant mother gets access to basic reproductive health services and investing in the health of women and children as a way of addressing the Millennium Development Goals 4 and 5. This commitment notwithstanding, the both levels of governments face the challenge of delivering the above services amid acute shortages. In such circumstances, complementary work of NGOs like Hifadhi Africa in addressing essential and realistically achievable services like Mama Kits in rural areas becomes a critical priority in the effort to reduce maternal mortality and morbidity. The project also endeavors World Health Organization (WHO) initiatives on low-cost technologies that aim to advance safe motherhood. Funds Raised The project sought to raise $1,000 but managed to raise $145 from 4 generous donors. We are sincerely grateful and greatly indebted. HAO procured 6 kits from the funds above. That being the case, the kits were not enough to cover all would be beneficiaries. In the circumstances, the distribution criteria put emphasis on the most vulnerable - a single expectant mother at Akwichatis village, sickly and PMTCT expectant mother at Cheptunoyo village, and 4 about to deliver mothers from Natan and Napeikore villages. ANC cards were relied on to determine the neediest. Mama Kit Utilization Outcomes While only six kits have been donated so far, health providers at our partner facility, Santa Clara Medical Centre in East Pokot noted great potential of the Mama Kit project to achieve two levels of outcomes: a. improved reproductive health service delivery; and b. improved utilization of the kit and related services by expectant mothers supported. Overall, the facility agrees that the gains expected of the 6 distributed Mama Kits have largely been achieved. The facility also noted that demand for the kit across the East Pokot and the larger Baringo county is high - an indicator of both perceived benefit of the kit by expectant mothers, and increase in the utilization of the reproductive health services. Lessons learned The initial plan was to use the kit as an incentive to mothers to attend the ANC by giving it only to those that attend at least four times. However, this approach proved impractical and was abandoned. Much as it encouraged mothers to attend ANC, often the kit is the only facility available to ensure clean and safe child delivery both to the mother, newborn and the midwives. The initial plan would mean chasing away mothers in labor or handle them in a risky environment without protection. Similarly, except for the districts where HAO operates, the initial plan to give out the kit to expectant mothers during ANC with directives to bring it along when coming to deliver was also abandoned. Much as this creates a sense of ownership, giving out the kit at ANCs had its own shortcomings. There is the potential to misplace them for Pokot community practice nomadism way of life - they do not live continually in the same place but move periodically. When handling PMTCT cases, midwives feel safer wearing two gloves on each hand. Challenges remain Like any other health initiative, Mama Kit has had some challenges to learn from in addition to the successes seen above. With distribution of the initial 6 kits, the community health promoters' major fear has been sustainability of supply. Supply of the kit has been intermittent and CHPs have run short of stock, threatening the gains made so far. Future Role of Midwifery Education Lack of funding is hindering Hifadhi Africa's plans to orient community health promoters (CHPs) and traditional birth attendants (TBAs) as maternity managers to sensitize expectant mothers at ANCs and in the communities about the kit with emphasis on its importance in having a clean and safe child delivery. Oriented TBAs and CHPs will then carry out an integrated reproductive health education (PMTC, safe pregnancy and clean and safe child delivery) among the mothers attending ANCs and in the communities. HAO has noted that visiting communities and holding dialogue with expectant mothers on the importance of the kit and clean and safe child delivery are difficult to arrange but more effective in making people appreciate the importance of the Mama Kit and the need to deliver in health units. Conclusion Hifadhi Africa Organization noted during implementation of this project that the factors contributing to high maternal mortality in East Pokot are many and include late referrals by TBAs, delays at the household level, distant health centres, lack of equipped labour wards and theatres, poor infrastructure such as poor roads and lack of ambulances among others. Mama Kit addresses only part of the problem. However small the area covered by the kit is, it makes a major contribution by ensuring that mothers deliver children in a clean and safe environment. To this end, it is gratifying to note that donors share the desire to ensure availability of funds for sustainability of the kit supply.

• HAO_Mama_Kits_Project_Report.pdf (PDF)