Saving Women's Lives:
The Skilled Care Initiative in Kenya
In Kenya, the Skilled Care Initiative was implemented in Homabay and Migori districts in Nyanza Province. This region suffers from some of the highest maternal mortality rates in the country (between 1,400 to 2,000 deaths per 100,000 live births). When the project began, the proportion of births taking place in health facilities was quite low (29% and 32%, respectively), and infant mortality rates were much higher than the national average.
FCI and the Ministry of Health introduced health systems improvements and counseling on birth preparedness in both districts. In addition, a community-level behavior change campaign was conducted in Homabay district.
Health systems interventions focused on both the skilled attendant (the maternity care provider) and the enabling environment. Thus, the intervention package included training interventions to update the skills of maternity care providers, along with interventions to:
Upgrade the infrastructure of health facilities
Address equipment gaps
Strengthen referral systems
These interventions were complemented by a broad-based behavior change campaign to promote the use of skilled maternity care before, during, and after childbirth. These behavior change efforts included counseling during ANC visits and a community-level campaign aimed at:
Heightening awareness about maternal health issues
Promoting birth preparedness and planning for delivery
Strengthening recognition of obstetric complications
Promoting the use of skilled care.
Improvements were observed in the capacity to provide the full range of maternal health services, including basic services such as antenatal, delivery, and postpartum care, as well as care for obstetric complications.
Large improvements were seen the routine provision of both delivery care and postpartum care at mid- and lower-level health facilities, which were a primary focus of the intervention.
An increase was seen in the proportion of women counseled on birth preparedness, including place of delivery and danger signs during pregnancy − advice that was found to be closely linked to women’s use of health facilities.
Women’s use of skilled maternity care increased in Migori district but remained essentially unchanged in Homabay. Among other factors, distance and the costs of care-seeking appear to be significant barriers to use of health facilities for delivery in Homabay district.
A costing analysis conducted in partnership with Abt Associates found that the most cost-intensive elements of the intervention package were activities aimed at upgrading the infrastructure of health facilities (e.g. improving facility structures and installing solar panels and improved water catchment tanks), and addressing gaps in essential obstetric equipment. Read more about the costing analysis.
FCI conducted extensive qualitative research in late 2002 and early 2003 with community members in Homabay and Migori Districts to gather detailed information on their experiences and opinions regarding the quality, availability, and utilisation of maternal health services in their communities. While study participants almost universally agreed that hospitals were the best source of medical care during delivery, they also identified a range of factors that limit women’s use of skilled care during pregnancy, delivery, and the postpartum period. These factors included:
Perceptions about capacity of health facilities
Concerns about the attitudes of health workers towards community members
Perceptions about the costs of facility-based delivery care
“I had months of bleeding with my first 6 deliveries— and 2 babies died—because I delivered at home. In the past, there were no drugs, no proper help from the doctors. But now I can go to this health facility with medicines and helpful doctors.”
"Fully operational mid and lower level health facilities were nonexistent in Homa Bay. Consequently, women would be delayed, and by the time they reached us at the district hospital, they were in extremely bad shape. This project strengthened the capacity of health staff, renovated and equipped health facilities in the villages. We now have fewer women coming all the way to the district hospital. This is the next best thing that happened to us after the loaf of bread."
—Dr Lusi Ojwang
Homa Bay Hospital Superintendent
Skilled Care Initiative Delivers Impressive Results
Between 2003 and 2005, FCI worked with Ministries of Health in Burkina Faso, Kenya, and Tanzania to improve the quality and availability of maternity care, improving services for thousands of women. Through an ambitious research effort, FCI evaluated and documented key strategies for increasing skilled care during childbirth. Click here to download an overview of the results from all three countries.
Safe Motherhood In The Community: A Flipchart This flipchart focuses on care during pregnancy, delivery, and the post-partum period.
Visit our Publications section to view our complete online catalogue of training and informational materials.
Film about FCI's Work Rangwe Health Centre in Kenya is one facility that has shown a remarkable change since the beginning of the Skilled Care Initiative. The facility is featured in our short film, “Changing Lives, Saving Lives.” When FCI began working in Homabay in 2001, Rangwe Health Centre simply could not offer delivery services. Through the Skilled Care Initiative, FCI has been working with the clinic’s staff and with community representatives to ensure that the facility has the capacity to provide obstetric care.