Maternal and Child Health is an all important area of our healthcare sector given that a lot of deaths that occur are preventable, and that it is so sad for a mother to lose her baby or to die while giving life. We recently had a talk with Henry Kilonzo who is in charge of Safaricom and MPESA Foundations on what they are doing to see that these unfortunate scenarios do not occur.
Your name please and what you do?
My name is Henry Kilonzo, I’m a senior manager in charge of Foundations Programs at Safaricom. My work entails identifying community needs which are relevant to our strategy which focuses on health, education, and economic empowerment. I also look at the relevant partnerships that we can build or establish to ensure delivery of our goal and also looking at community and doing the story of our transformation.
What drives Safaricom to be so keen on maternal health?
We believe that businesses thrive when communities thrive. Kenya is one of the countries with high maternity mortality rates currently standing at 364 per 100,000 births. We also have a high number of children passing on when they’re below 5 years, below 1 year and others during birth. We looked at these statistics and realized that we need to invest in maternal and child health to ensure that mothers are not dying when giving life, children are not dying, and generally improving the quality of life.
It is in the spirit of Safaricom that purpose comes before profits. We invest in communities to thrive so that business can thrive. That is what drives us.
What areas of maternal health do the foundations place more emphasis on? For example coming all the way from donation of sanitary towels to Fistula management and treatment?
In terms of maternal and child health, we invest in end to end programs. We have what we call the 3D model which is the 3 delays of care. Delays that cause mothers and children to lose their lives.
One D is the delay to seek care, where mothers do not go antenatal clinics. Then we have the second D which is the delay to reach care. Where mothers are late to get to the facilities due to gaps in infrastructure and non-functioning referral systems. The third D is the delay to access care. This is where mothers go to facilities which may not be equipped, they may not have sufficient human resources for health, they may not have the right consumables or medication and all that.
We also focus on technology which cuts across all these. Safaricom is a Telco company so we’re leveraging on technology to improve maternal and child health outcomes.
In addition, we also improve advocacy because while we are implementing these maternal, newborn and child health programs, we usually identify key advocacy issues that we pursue through the different partnerships that we have to ensure sustainability in the long term. These partnerships include County and National Government.
So we do end to end from the community side, we work closely with community health framework like health workers and volunteers who are trained on maternal health. They identify pregnant mothers in the villages, train them on safe pregnancy, and walk the journey with them until they deliver in health facilities. Each of the community health workers has a phone and we have developed technology which they use to identify, register, and monitor all the pregnant mothers. This is technology we can access from the offices here in Nairobi.
Moving to referrals which after mothers have been empowered to deliver in health facilities, we then work with the County Governments to make sure that the ambulance frameworks are working. In some counties we buy ambulances or facilitate movement. In Lamu for example, we are facilitating transfer of mothers all the way from Faza which is Lamu East to deliver at King Fahad hospital in Lamu. This is a distance that takes around 3 to 4 hours by boat and we facilitate that to ensure that mothers get to hospital in good time even in cases of complications.
In terms of care, we construct fully equipped maternities, High Dependency Units for mothers, new-born units for the babies. Case in point – last year we launched the first maternal High Dependency Unit in Kenya at Coast General Hospital in partnership with the County Government of Mombasa. We are now currently doing another one in Maternal HDU in Kabarnet referral hospital in Baringo County.
The purpose of these is to ensure that when mothers come in with complications, they are handled in good time. So, it’s a unique model that we are using, and we are also considering other counties in Central Kenya and the Western region.
We also incentivize mothers to deliver in health facilities. In all the counties where we are working, every mother who delivers in a health facility is given when we call a mama and baby pack. This pack has all what the mother and baby require immediately after birth, like baby clothes, baby shawl. The bag itself is so good that the mothers use it to go for immunizations. Infact we have cases where mothers even book the mama pack when they come for their first ANC.
Because of the challenges in the country in terms of referral systems and ambulances that may not work, some mothers have prolonged labour. With prolonged labour we know that mothers develop complications during and even after delivery. Some of these mothers develop fistula and so we integrated fistula management in our programmes and through partnerships with Flying Doctors Society of Africa. We have been funding fistula camps in different regions like Kitui, Kisii, Embu, Nyeri, Kenyatta National Hospital, and many other regions. We want to ensure that we restore their dignity in case they develop fistula.
Do some counties have more severe maternal health challenges? Lamu for example which gets mentioned quite a bit? And does the foundation assign more time, funds and effort to these counties?
Our interventions at community level are evidence informed. We have the report by UNFPA that shows that 99% of maternal mortality in Kenya happens in 15 counties. Out of those 15 we have 6 that contribute 60% of these deaths and Lamu is one of them. We look at data to make decisions and when you look at the maternal mortality, illiteracy and poverty levels, you find that Lamu is a vulnerable county.
So yes, there are some counties that have more severe challenges than others in terms of infrastructure, referrals, and human resources. One unique challenge with Lamu is that it is an archipelago of islands meaning that transport is mostly by water and this is very expensive. The communities which are in the East are more vulnerable than those in the West because of the island setup.
Two, Lamu has insecurity problems because of Boni forest. This complicates matters because we have some donors and implementing partners pulling out of the county. Like by the time we went to Lamu in 2018 there were like two or three partners working there while the others had left because of insecurity.
By the time we got into Lamu the maternal mortality was 676 per 100,000 live births compared to the national statistic which is 362 per 100,000. Skilled deliveries were at 53% and the percentage of children completing all immunizations was 63%. You can see the indicators were very low compared to the national figures so we got in there to see how we can be able to improve this situation.
When you look at Baringo for example, there are more children dying during birth. The neonatal death rate is 61% compared to the national which is around 32%. This is almost double.
So each county has unique challenges and the best thing to do is to look at not only the burden but also who is investing there so that you do not have a lot of partners going to one county and we end up with double funding and denying other counties the benefits.
If for example went to Lamu and found the need is there but we have a lot of partners there we could have maybe made the decision not to invest as heavily there. But there was nobody. As we speak now, children in Faza are not being put in boats to get to King Fahad hospital. We have a new born unit now in Faza and the county Government has provided all the required human resources for health.
We just finished Maternal Mother and Child Health wing in Mpeketoni because we found out that mothers were being attended on a corridor and it is even more complicated now with COVIC-19. So we did a fully equipped MCH wing to ensure that mothers and children get dignified services.
We are also doing a maternal High Dependency Unit at King Fahad Hospital to ensure that mothers and babies who have complications get quality services. The county has committed to provide the consumables and the human resources for health to ensure that it works.
We also moved down to Witu and did a maternal shelter. We did a maternal shelter in Lamu because it is unique in that it serves people from far off areas in Kilifi and Tana River counties. A maternal shelter is like a house where mothers who come from far can even stay for a week or two as they wait to deliver. They’re observed by the doctors and also get support from their families. We borrowed this idea from Garissa where UNICEF who did some years back and they were very successful. They have worked well in down south Malawi where they have worked very well. The context there is not very different from what we have here in Kenya in terms of challenges around healthcare. We said let’s try this in Lamu and if it works we can replicate it in other areas where mothers end up delivering at home because they have nowhere to stay in a health facility.
When mothers stay in maternal shelters they’re not sick. They are staying there because they came from 100 or 200 km away and it is risky for both mother and baby to travel that far when the mother is already due.
Does Safaricom Foundation plan on having maternal shelters in every county?
Our investments are informed by need. If for example we see that a maternal shelter is very successful in areas where we have invested, and then we go to other counties and see that they also need maternal shelters and the counties are willing to support, then we can be able to support. But we cannot say that we will do this in every county before we assess the need on the ground and also resources available. We take our support to where the need is highest.
What criteria does Safaricom Foundation use to prioritize which counties to offer maternal support to?
Earlier on I mentioned the report that talks about the 15 counties which contribute to 99% of maternal deaths in this country. These are the counties that we have been focusing on. We can not yet say that we will go to every county, but we will continue to look at the needs on the ground and make decisions around which county to work with.
We also look at county engagement, receptiveness, and willingness to be part of the partnership because we follow what we call a co-creation process. We look at the resources and have meetings with the county and other health focus organizations and what they do. So when we come in we are not coming in to do what other organizations are doing. We come in and become part of the county health team so that we can participate in review of the progress, sharing successes, learning together, and sometimes building the ship as we sail.
Health is very dynamic, communities are very dynamic, so we have to ensure that we remain relevant. In other counties where we’re not doing end to end maternal health and health programs, we’ve been able to do a lot of infrastructure. Like in Makueni, Narok and Uasin Gishu where at the Moi Teaching and Referral Hospital we equipped their new born unit and helped them establish their first ICU for newborns. We also did a maternity at Moiben which is also in Uasin Gishu, and we’ve also done something in Eldoret West.
In Kilifi we are doing their state-of-the-art newborn unit. This is a heavy investment which is now 99% complete and will be handed over in the next one or two months. In Mandera we have done a dispensary which also has a maternity wing and even in Nairobi here, we have supported the Westlands Health Center maternity. In Kangemi and St. Josephs too.
We have done maternal health related infrastructures in more than 70% of the counties in Kenya.
When the foundation goes to a hospital and sets up physical infrastructure, is there follow-up on usage and/or possible misuse?
As a foundation we have our strategy that focusses on education, economic empowerment, and health. Other than developing an operational strategy for our plans, we also developed a monitoring plan and we have in-house monitoring and evaluation experts. We also have other outsourced services for monitoring and evaluation.
Every month we are out there monitoring the performance of our projects. We have routines where we go and sit down with the facilities, we check whether they are in use, how many people have benefited since construction, and whether the equipment is in good condition and whether the county is maintaining because we sign MOUs with these counties.
So, yes. Because it is a partnership, we do go back and check whether the partners are also doing their bit. After some time we also go back and do a further assessment to gather what the real impact of our investment is. That is what we also use to inform our other programs and projects in other counties.
How much has COVID-19 interfered with the Foundations’ operations?
When we had the first case, there was the Government’s guidelines on social distancing and travel. Our community engagements definitely were interfered with because most of the times we are otherwise out there with the communities and now we could not do that.
We had constructions going on in different regions in the country. The contractors on site and partners on ground had to reduce their numbers so they could practice social distancing.
Our community health volunteers had to reduce their internal meetings for planning and reduce the level of interactions with the households. To mitigate this, we made sure that the community health workers in maternal health programs were fully kitted to protect themselves and the people they were working with. We quickly supplied PPEs, sanitizers, masks, gloves, and we also did a lot of sensitization on how to operate.
In terms of constructions, we had to negotiate new timelines with our partners. As Safaricom we are in almost all major towns, so we have our regional offices and our regional colleagues were able to support handovers instead of somebody leaving Nairobi.
We also had to look at our budgets and plans for the year and innovate so that we are Covid sensitive. We had to align so as to include key activities to help in community response. As we speak now, we have been able to support 31 counties with PPEs. We have supported many NGOs, community groups and youth groups to respond to the impact of Covid. We have also been working with other organizations to ensure that children are able to learn from home where applicable by providing connectivity and devices.
The technology that our community health volunteers use came in handy because with technology you don’t need to go to a household. We were able to send messages say twice a week Mondays and Thursdays depending on the stage of pregnancy, through whatsapp groups and chat groups, and calls to the mothers to check how they and their newborns are doing.
To wrap up, we worked together in 2016 for a M-PESA Foundation farming project in Nyalani in Kwale. How is that going?
The Nyalani project is doing really well. Officially the grant ended in 2018 and the county took over. That is the success.
As we speak now, the county is investing around 100 Million to ensure the farmers continue to grow and sell high value crops and that the cooperative continues functioning. Currently what we are doing as M-PESA Foundation is solarizing water pumping. Because initially they were using diesel to pump water from the dam to the farms. We decided to reduce the burden around fuel and invest a further Ksh.16Million to convert to solar energy. We are documenting this and we have seen that farmers have been able to grow, improve their housing from mud to stone houses, include livestock in their farming, and others have now been able to take their children to school.
The most exciting outcome of this project is the change of mindset by the community in Nyalani. They were used to subsistence farming and crop never got to harvest level. Now there is that change of mindset that they can be able to plant in bulk and sell. To us that is one of the best outcomes.
The dam also provides water through the Coast Water and Sewerage Company which now pumps water to serve the community and there is a lot of fishing happening there. This is an unanticipated outcome. We did not build the dam for fishing, but it is now a very positive outcome of the project.
The other good thing is that the County has now owned the program and allocated resources. It has now been moved to the Governor’s office and there is a team that has been tasked by His Excellency Salim Mvuria to ensure that the project continues to run.