While improvements have been made in recent years, maternal and infant mortality rates in Kenya remain unacceptably high; 362 maternal deaths out of every 100,000 live births, and 39 infant deaths out of every 1,000 live births (Kenya Demographic Health Survey, 2014). It is estimated that 7,700 Kenyan women die each year because of pregnancy related causes. This translates to approximately 21 women every day and almost one Kenyan woman per hour (Ministry of Health, 2010).
Bungoma County lies far behind the national average for the uptake of maternal and new born health services. Only 41% of births in Bungoma are conducted by a skilled attendant, compared to the national average of 62%. Bungoma is ranked 43rd out of the 47 counties in Kenya for skilled birth attendance (KDHS, 2014).
The county is home to an estimated 1.6 million people. Many of the reasons for the high number of maternal and neonatal deaths are related to challenges in accessing facility based services, such as women’s lack of power in decision making, relatively high costs of transport to health facilities, and long distances to the nearest health facility.
The MANI (Maternal and Newborn Improvement) Project in Bungoma is working with the County Health Management Team (CHMT) to improve the survival of mothers and newborns. MANI is strengthening the health system to deliver high quality maternal and newborn health services, and supports women to access these services. Part of this project is a voucher scheme, in which pregnant women who would otherwise not afford transportation are given a transport voucher for facility delivery.
Affordable transport has been identified as a key obstacle for poor women in Bungoma in accessing maternal and newborn services. Most communities are served by motorised vehicles (boda bodas, cars, matatus) but the cost of transport continues to contribute to life threatening delays in accessing care.
With support of the MANI project, community health volunteers register local transport providers and identify poor women to receive a transport voucher. When they are due to deliver, the mother contacts a registered driver who takes her to the nearest health facility. The health worker records the voucher and once verified, MANI sends a mobile money payment to the transporter.
The transporters are available 24 hours a day, seven days a week. Using local transport, such as boda bodas, communities are leveraging their own resources to save the lives of women and their babies.
Claire is 28 years old and lives in Kiminini, Tongaren. Her husband is a casual labourer who mainly supports construction work and Claire does not have a job. On average they live on less than $1 per day.
They have four children; three were born at home and one in a hospital. During her first three pregnancies Claire didn’t attend any antenatal clinics, because she could not afford the transport to the nearest health facility which is 7km away.
Whilst she was pregnant for the fourth time, the community health volunteer told Claire about the MANI voucher scheme, and the importance of a hospital delivery. When Claire went into labour, she used her husband’s phone to call the community health volunteer who put her in touch with a registered driver. She used the transport voucher to pay for her travel to Ndalu health centre, where she gave birth to her fourth child.
Jane, a community health volunteer who has been working in the area for 20 years, says:
“The voucher scheme strengthens community referral to the facility especially for poor expectant mothers. It complements the work we do by providing a realistic solution to problems of affording transport to the health facility. The subsidy also provides some income to community health volunteers once a voucher client delivers in the health facility. Though not very much, this income is able to meet some basic needs of the community health volunteer as we do not have a salary.”