S9E2 - Improving the Quality of ANC and PNC in Kenya

Kim: 00:00:05

Hello listeners and welcome to the connecting citizens to science podcast.

Kim: 00:00:09

I'm Dr.

Kim: 00:00:10

Kim Ozano and together with a selection of co-hosts from around the world, we discuss

Kim: 00:00:14

the ways in which people and communities connect with research and science.

Kim: 00:00:18

We hear from patients and survivors, health workers, policy makers, scientists,

Kim: 00:00:23

and implementing research organisations about the methods and approaches that

Kim: 00:00:27

they apply to co-produced knowledge to address current global health challenges.

Kim: 00:00:31

Thank you for listening and onto this week's episode.

Kim: 00:00:34

Hello listeners.

Kim: 00:00:34

And welcome back to the connecting citizens to science podcast

Kim: 00:00:38

or welcome for the first time.

Kim: 00:00:39

Thanks for joining us.

Kim: 00:00:41

This month's series is all about improving the quality of antinatal and postnatal

Kim: 00:00:45

care in Nigeria, Kenya, and Tanzania.

Kim: 00:00:49

And today we are going to Kenya to hear more about the work they are doing there.

Kim: 00:00:53

So Kenya attained, lower middle income status in 2014 and while the good news is

Kim: 00:00:59

that poverty rates declined, the absolute number of poor people did increase.

Kim: 00:01:05

And the majority of those are women.

Kim: 00:01:07

So the focus to improve services for women is more crucial than ever before.

Kim: 00:01:13

Despite progress in health policy and service delivery infrastructure Kenya's

Kim: 00:01:17

maternal mortality ratio remains high at 342 per hundred thousand live births.

Kim: 00:01:24

And recent analysis shows why disparities of maternal and neonatal

Kim: 00:01:28

health indicators across and within the counties, with access to scaled

Kim: 00:01:32

birth attendance during childbirth ranging from a low 22% to a high 93%.

Kim: 00:01:39

So some real variation across the country there.

Kim: 00:01:42

So today's episode, we will be talking about in-service capacity

Kim: 00:01:45

strengthening on antinatal care and postnatal care and quality improvement

Kim: 00:01:50

methodologies in 61 health facilities across three target counties.

Kim: 00:01:55

The project which is supported by global fund will provide technical

Kim: 00:01:59

assistance generate evidence to inform decision making and policy

Kim: 00:02:03

making in support of maternal and neonatal health quality of care.

Kim: 00:02:08

Our guests today are Amina Baraka, who is a nursing officer in charge of

Kim: 00:02:13

Vihiga county referral hospital, and Fatuma Iman, who is the reproductive

Kim: 00:02:18

health coordinator at Garissa county.

Kim: 00:02:21

Amina and Fatima will be talking about improving the quality

Kim: 00:02:24

of ANC and PNC antenatal care and postnatal care in Kenya.

Kim: 00:02:30

They will be having a particular emphasis on their own county

Kim: 00:02:34

experiences of quality improvement.

Kim: 00:02:37

Thank you very much for listening and let's introduce our co-host.

Kim: 00:02:41

Hi, Lucy.

Kim: 00:02:42

How are you today?

Lucy: 00:02:43

Hello, Kim.

Lucy: 00:02:44

Good afternoon from Nairobi.

Lucy: 00:02:46

Good day to all our listeners across the globe, wherever

Lucy: 00:02:48

you're listening to us from.

Lucy: 00:02:51

My name is Lucy Nyaga I am the country director Liverpool School

Lucy: 00:02:54

of Tropical Medicine in Kenya.

Lucy: 00:02:56

I have a background in medical anthropology and public health with

Lucy: 00:03:00

some extensive experience there nearly 20 years, uh, working in programming

Lucy: 00:03:04

and, uh, most of this, uh, time that I've worked on programming, I've worked

Lucy: 00:03:08

on aspects of maternal and newborn health . And so I'm really happy

Lucy: 00:03:12

to be here to be speaking with our guests and I hope that our listeners

Lucy: 00:03:16

will be happy and enjoy listening to us and our experiences from Kenya.

Lucy: 00:03:21

Thank you, Kim.

Kim: 00:03:22

Wonderful.

Kim: 00:03:23

Thanks very much.

Kim: 00:03:24

So let's meet our guest.

Kim: 00:03:26

Fatima, how are you today?

Kim: 00:03:28

Uh, tell us a bit about yourself, your background and where you are.

Fatuma: 00:03:32

I am Fatuma Iman I come from the Northern region of Kenya, which is

Fatuma: 00:03:36

called Northern part Garissa county.

Fatuma: 00:03:40

I am a nurse by profession.

Fatuma: 00:03:42

I have a basic degree in nursing and a master of science in

Fatuma: 00:03:47

community health and development.

Fatuma: 00:03:49

I have worked with the ministry of health for the past 35 years.

Fatuma: 00:03:53

Uh, previously I've been coordinating maternal newborn health reproductive

Fatuma: 00:03:58

health in the entire Northern Kenya, which was three counties [place names].

Fatuma: 00:04:03

Garissa county is among the 15 counties with high burden, with the high,

Fatuma: 00:04:10

burden of maternal mortality in Kenya.

Fatuma: 00:04:13

It is the one, uh, it's among the counties, which has made Kenya not to

Fatuma: 00:04:17

the, our indicators are all the time low.

Fatuma: 00:04:21

And this is because of, we have a porous border with Somalia and Ethiopia , we

Fatuma: 00:04:26

have high insecurity levels and 80% of our community are nomadic pastoralists.

Fatuma: 00:04:32

This is where now we want to reach our mothers who are in the rural

Fatuma: 00:04:37

area at least to have quality maternal and newborn care services.

Fatuma: 00:04:42

I have been working 35 years with the ministry, uh, around 20 years, I've been

Fatuma: 00:04:47

coordinating maternal newborn health and the last two years with the this

Fatuma: 00:04:51

global fund of LSTM, I've been involved in the antenatal and postnatal program.

Fatuma: 00:04:58

I'm a mother of two, and I have a grandson of one and a half years old.

Fatuma: 00:05:03

My first born is a nurse and my second born is a student

Fatuma: 00:05:07

medicine in her second year.

Fatuma: 00:05:09

That's all about me.

Kim: 00:05:11

I think that's a great position to be in, within the family to have

Kim: 00:05:13

so many people interested in health.

Kim: 00:05:15

So thank you for sharing that about yourself and your background.

Kim: 00:05:18

It sounds like you when planning services, you have to consider lots

Kim: 00:05:23

of different cultures and backgrounds with the, I think you called it

Kim: 00:05:26

a porous border, is that correct?

Fatuma: 00:05:28

Yes.

Fatuma: 00:05:29

We border with Somalia and Somalia remember from 1991, they

Fatuma: 00:05:34

never had a stable government.

Fatuma: 00:05:36

We host the largest refugee camp in Garissa county, which is called Dadaab

Fatuma: 00:05:41

I think you have heard, so we have many different populations in the refugee

Fatuma: 00:05:46

setup which we serve as a county.

Kim: 00:05:49

Thank you very much.

Kim: 00:05:50

And just before we move on, could you tell me within the refugee campus,

Kim: 00:05:55

what are some of the things you have to consider when you're thinking about

Kim: 00:05:58

providing services to that population?

Fatuma: 00:06:00

Normally those, the refugees are under the UNHCR support, but

Fatuma: 00:06:04

there are three camps normally one is managed by MSF, another one is

Fatuma: 00:06:10

managed by Kenya red cross, and the other one is managed by IRC.

Fatuma: 00:06:14

They report to us, we train them when we are training our healthcare workers.

Fatuma: 00:06:19

We do support provision and when we are doing any programs, we normally

Fatuma: 00:06:24

include them in all our activities.

Fatuma: 00:06:25

But by and large, it's not the government of Kenya which supports

Fatuma: 00:06:29

them, they're supported by the UN and those specific implementing agencies.

Fatuma: 00:06:34

But we have a role in their, in the management of maternal newborn

Fatuma: 00:06:38

health they're contributing to our maternal newborn indicators.

Kim: 00:06:43

Thanks very much.

Kim: 00:06:44

Uh, thanks, Fatima.

Kim: 00:06:45

It sounds like you are, uh, kind of dealing with lots of

Kim: 00:06:48

different stakeholders and lots of different factors.

Kim: 00:06:50

So I look forward to hearing about that but, um, Amina over to you.

Kim: 00:06:55

Could you tell us a bit about yourself, where you are and a little

Kim: 00:06:58

bit of your background, please.

Amina: 00:06:59

Thank you.

Amina: 00:07:00

Kim my name is Amina Anyango Baraka a nurse midwife working in Vihiga county

Amina: 00:07:07

referral hospital in Vihiga county.

Amina: 00:07:10

I'm a principal nursing officer and, uh, currently I am the

Amina: 00:07:14

nursing director of the hospital.

Amina: 00:07:16

I have been in service for the last 28 years and, uh, serving in various

Amina: 00:07:23

capacities as MOH at one time and then as a service provider, as I

Amina: 00:07:29

began my service, I've also been involved in, uh, reproductive health.

Amina: 00:07:35

I've done higher diploma in reproductive health, apart from my, uh, bachelor's

Amina: 00:07:40

degree in nursing and currently doing masters in midwifery at the Moro.

Amina: 00:07:47

And then I have been working in the area of RMNH.

Lucy: 00:07:53

I would like to clarify MOH.

Lucy: 00:07:55

Uh, we normally use it here in Kenya ministry of health and RMNCH is

Lucy: 00:07:59

productive maternal and newborn health.

Amina: 00:08:01

For almost a period over 15 to 18 years, I've been a trainer at

Amina: 00:08:06

the decentralized training center, uh, for reproductive health training

Amina: 00:08:10

at Kakamega county referral hospital.

Amina: 00:08:13

Before I moved back to Vihiga, uh, in their program, I've

Amina: 00:08:17

been a, I I'm a master trainer.

Amina: 00:08:20

I am a mentor and, uh, I am also a supervisor in the facility of the,

Amina: 00:08:27

uh, reproductive health services and nursing as a forest Kenyans training

Amina: 00:08:33

system is, uh, um, designed, mostly nurses are also trained in midwifery and

Amina: 00:08:41

therefore I double in both, uh, serving the nursing fraternity and also, uh, the

Amina: 00:08:46

midwifery fraternity in the hospital.

Amina: 00:08:49

We have been actively engaged in terms of mobilization with the stakeholder

Amina: 00:08:54

forums to source for funding to support reproductive health services.

Amina: 00:08:59

Also as staff progression and or training in terms of, uh, ensuring that their

Amina: 00:09:06

skills and knowledge is kept up to date and also, uh, development of, uh,

Amina: 00:09:12

standard operating procedures for the facility and also the implementation

Amina: 00:09:17

of the guidelines that are developed at the county and the national level to

Amina: 00:09:22

ensure that we adhere to the standards and the expectation of WHO as well.

Amina: 00:09:27

Uh, basically I'm a mother of three, two daughters and one son, uh,

Amina: 00:09:33

none of them has given me Mjukuu or a grandchild for that matter.

Amina: 00:09:38

I have a first born who is an engineer, a girl she's based

Amina: 00:09:42

at the audit, uh, in Nairobi.

Amina: 00:09:45

I have a son who is a lawyer, 28 years old.

Amina: 00:09:49

And my last born is in form 4 four the [school name].

Kim: 00:09:53

Thank you very much.

Kim: 00:09:54

It sounds like you have a very multidisciplinary household.

Kim: 00:09:57

Um so that sounds also very useful.

Kim: 00:10:01

Could you tell us a little bit more about the stakeholder forum?

Amina: 00:10:04

In Kenya, we have quite a number of interrelated, intersectoral

Amina: 00:10:09

groups that work together to attain a certain achievement.

Amina: 00:10:13

So we have quite a number of stakeholders who come together.

Amina: 00:10:17

We put up our agenda together, sometimes we bring all our resources together and

Amina: 00:10:23

then we define the direction that we want to take as a county and eventually

Amina: 00:10:28

as a country in terms of improving our indicators, uh, at the end of the day.

Kim: 00:10:34

So it's kind of a coordination forum to bring all interested parties

Kim: 00:10:38

in health, together for decision making.

Kim: 00:10:40

It sounds like you have a lot of experience in delivering training

Kim: 00:10:43

and supervision and mentorship, which is wonderful and quite new to our

Kim: 00:10:48

connecting citizens to science podcast.

Kim: 00:10:50

Are the communities you work with and the, the patients and the mothers

Kim: 00:10:54

and the children involved in kind of helping to develop that training

Kim: 00:10:59

or helping to develop services.

Amina: 00:11:01

Yes, we do involve the community.

Amina: 00:11:05

In the community, we have the community strategy and in the community strategy,

Amina: 00:11:11

we select people who are from those communities whom will give the, basic

Amina: 00:11:17

trainings on simple matters, primary matters, uh, concerning health.

Amina: 00:11:22

And, uh, they also act as a bridge between us.

Amina: 00:11:25

They bring us the information from the community, what the community

Amina: 00:11:30

are going through, what are some of the things they're experiencing

Amina: 00:11:33

that are related to health?

Amina: 00:11:35

We therefore go down and investigate if they bring us issues.

Amina: 00:11:39

And then we also give them feedback on how we plan to respond to their issues.

Amina: 00:11:45

Uh, we also do exit interviews to our clients at certain points, so

Amina: 00:11:49

that they tell us, what is the feel?

Amina: 00:11:51

How do they perceive the services that we do offer to them?

Amina: 00:11:56

Uh, we also have in those forums, we also invite.

Amina: 00:12:00

Uh, people, uh, their community own resource persons, the people they think

Amina: 00:12:06

can assist them in making decisions.

Amina: 00:12:10

So in those forums they're able to share with us, what are some

Amina: 00:12:14

of the difficulties they have in terms of health service delivery.

Amina: 00:12:19

And we are able to, uh, come up with the plans and implement whatever

Amina: 00:12:24

strategy that can assist them in terms of alleviating their problems.

Kim: 00:12:28

And just in terms of where your situated, what is

Kim: 00:12:32

the population like there?

Amina: 00:12:33

So in Vihiga county, we have a population of about 600,000

Amina: 00:12:37

people with a population density of about 1200 per square kilometer.

Amina: 00:12:44

That means it is a very densely populated environment and, the latest health

Amina: 00:12:51

indicator survey shows that we have a maternal mortality of about 49 women

Amina: 00:12:56

per 100,000 births, most of our maternal mortalities are within the postpartum

Amina: 00:13:02

period, but we are still not able to reach these women in the critical time, the four

Amina: 00:13:10

weeks, the six weeks and moving forward.

Amina: 00:13:12

Uh, you find because of the population density, uh, the issues

Amina: 00:13:18

of health problems still remains a very big challenge to this county

Kim: 00:13:24

So it sounds like we have two very different context here where you are

Kim: 00:13:28

Amina, it sounds very urban, um, with many different challenges and, and Fatima, you,

Kim: 00:13:34

you have the border issues there as well.

Kim: 00:13:36

So just, uh, quickly before we move on Fatima, is there any other considerations

Kim: 00:13:41

you have to think about when trying to get the views of the communities you

Kim: 00:13:45

work with so that they can inform service delivery or be involved in research?

Fatuma: 00:13:50

Uh, thank you very much in our county, what we use basically the

Fatuma: 00:13:54

community strategy we have Village health committees and the village health

Fatuma: 00:13:58

workers, community health workers, and village health Workers, VHC then

Fatuma: 00:14:04

on top of that in our county, we use religious leaders because most of the

Fatuma: 00:14:10

mothers, sometimes they believe more when the religious leader says the

Fatuma: 00:14:15

importance of delivering in a hospital.

Fatuma: 00:14:17

They take more from the religious sector than us.

Fatuma: 00:14:20

However, in every 10 household, we have a community health extension worker.

Fatuma: 00:14:25

They create demand for this mothers to attend anenatal care, skilled

Fatuma: 00:14:31

delivery and postnatal care.

Fatuma: 00:14:33

However, still our numbers are low because majority of the mothers are in the rural

Fatuma: 00:14:38

area because they have animals, they look for pasture and water and more.

Fatuma: 00:14:44

So our land is dry land.

Fatuma: 00:14:46

We don't have rain all the time.

Fatuma: 00:14:48

We are in a drought season most of the year.

Fatuma: 00:14:50

So majority of our communities are in the hard to reach area.

Fatuma: 00:14:55

We normally do an integrated outreach services whereby you do immunization

Fatuma: 00:15:00

antenatal, postnatal care and sometimes we have designed a mobile clinics

Fatuma: 00:15:06

whereby uh, there were some vehicles where they spend in a, a unit or

Fatuma: 00:15:10

a village for some weeks, and even some mothers deliver inside those.

Fatuma: 00:15:15

We have them beyond zero vehicle, which is, which runs like a mobile clinic.

Fatuma: 00:15:19

We make at least most of our communities to get services.

Fatuma: 00:15:24

However, still we are not at the standard where we can say we can

Fatuma: 00:15:28

reach everyone in this county.

Kim: 00:15:30

I think that's really important for us to understand moving forward

Kim: 00:15:33

in the episode, I'll hand over to Lucy now to explore the program that

Kim: 00:15:38

you're working on right now to try to improve both quality and reach of

Kim: 00:15:42

services from mother and children.

Lucy: 00:15:44

When you look at what we are trying to do this global funded

Lucy: 00:15:47

program, the quality improvement of integrated HIV, TB, and malaria

Lucy: 00:15:51

services into antenatal and postnatal care, I think the key focus of this

Lucy: 00:15:56

project is the capacity strengthening.

Lucy: 00:15:58

So what has the project introduced to address some of those gaps?

Amina: 00:16:02

We are trying to work on the, uh, human resource capacity.

Amina: 00:16:08

There have been a training on the master trainer.

Amina: 00:16:12

Then the mentorship program so that we have mentors in the various

Amina: 00:16:16

facilities where we work that are able to continually update the skills

Amina: 00:16:22

of the other service providers.

Amina: 00:16:24

So that even when we get other providers leaving, the team that is remaining

Amina: 00:16:30

behind already has the, have the skill and knowledge that is required for

Amina: 00:16:35

the continuity and sustainability of the services that are there going on.

Amina: 00:16:40

So there has been a support on the postnatal care and

Amina: 00:16:46

antenatal care mentorship using the participatory approach.

Amina: 00:16:51

The program has been able to support us with the, the humanistic

Amina: 00:16:56

models that we require for that participatory approach, and also

Amina: 00:17:00

supported us in the training itself.

Amina: 00:17:03

Every two weeks at minimum sessions of mentorship with the providers

Amina: 00:17:09

in each department, so you raise the areas of concern that they

Amina: 00:17:13

think we need to talk about again.

Fatuma: 00:17:16

So project also supports evidence generation to support the

Fatuma: 00:17:20

scale up of intervention packages.

Fatuma: 00:17:23

Everything has come back to the improving of maternal and newborn

Fatuma: 00:17:26

health is through the mentorship and the skills that, where they practice

Fatuma: 00:17:31

in their own facilities after training.

Lucy: 00:17:34

Thank you, Fatma, just for the sake of Garissa because of your

Lucy: 00:17:36

different contextual landscape being nomadic , facilities being very far apart.

Lucy: 00:17:42

How do you see this program and the interventions of mentorship the

Lucy: 00:17:46

equipment that is there, how does it help that mobile population?

Fatuma: 00:17:50

By the way, this is the way to go, because when you have one or two

Fatuma: 00:17:53

staffs in one of the farthest corner or of the county, every time you cannot be

Fatuma: 00:17:59

calling for this guy or this nurse to be coming for a class based training.

Fatuma: 00:18:03

In Garissa we have a pool of mentors across cutting from the county

Fatuma: 00:18:07

level and the county referral hospital and the subcounty level.

Fatuma: 00:18:11

So, what we are anticipating is at least we do rotational.

Fatuma: 00:18:16

We go to them at their facilities, not calling them at the, at

Fatuma: 00:18:20

the headquarter level, whereby service delivery will be disrupt.

Fatuma: 00:18:24

So our plan is at least to make a rotational basis where the mentors can

Fatuma: 00:18:30

go around in the far flank facilities and the capacity build our staffs,

Fatuma: 00:18:35

mentoring them and on job training.

Fatuma: 00:18:37

That one will sustain better than with withdraw that staff from the

Fatuma: 00:18:42

facility, where are he or she's working.

Lucy: 00:18:44

Would you say there's something different with this program

Lucy: 00:18:47

compared to how you've been doing other programming work, is there

Lucy: 00:18:50

anything different in your counties?

Fatuma: 00:18:53

The other programs approach were not doing this detailed, uh, mentorship

Fatuma: 00:18:57

supports, but, uh, with LSTM and this global fund program what we have is

Fatuma: 00:19:03

we have cross cutting, uh, energy.

Fatuma: 00:19:06

The goodness with this program of ours is we have a scheduled, a program that,

Fatuma: 00:19:11

uh, topics where our healthcare workers, they have their scheduled, like this

Fatuma: 00:19:16

week in that date of that week in Garissa county referral, where we are doing a

Fatuma: 00:19:21

mentorship on the newborn Rosa station.

Fatuma: 00:19:24

In another facility, we have a, a mentorship.

Fatuma: 00:19:28

The use of magnesium sulphate so this one is a continuous one

Fatuma: 00:19:32

compared to the other other partners.

Fatuma: 00:19:35

What we do with them is maybe after one month or after three months where we,

Fatuma: 00:19:39

we come a quarter, then we say, what have we achieved and what we have not.

Fatuma: 00:19:43

But the goodness with this one is consistent.

Fatuma: 00:19:46

And where we see there's a facility or a subcounty, which is

Fatuma: 00:19:50

silent all the way from LSTM, uh, technical assistant at the Nairobi.

Fatuma: 00:19:55

They tell us Fatma, what is happening with that facility?

Fatuma: 00:19:58

Then I, I, I, I crosscheck with the facility, what is happening.

Fatuma: 00:20:02

So sometimes the, when the workload is, is too much, they might forget the

Fatuma: 00:20:07

scheduled mentourship which was planned.

Fatuma: 00:20:09

So I see this one is like, uh, we are focused on a daily basis if I say.

Amina: 00:20:14

Just to add on what Fatma say, the process has given us the opportunity

Amina: 00:20:19

now to drive the agenda forward.

Amina: 00:20:22

It is basically we are the trainers.

Amina: 00:20:24

We are the mentors.

Amina: 00:20:26

This approach, it is very flexible.

Amina: 00:20:28

We are able to look at ourself as a county or as a subcounty or as a facility.

Amina: 00:20:33

What are the appropriate, times for us and what is our key need for this

Amina: 00:20:38

time that we want to address in this process of training and mentorship

Amina: 00:20:42

or on job training for our ourselves.

Amina: 00:20:44

So this to me will.

Amina: 00:20:47

Enhance sustainability and we'll also demystified the thinking that

Amina: 00:20:52

people who go for training, they are able are the people to carry the, the

Amina: 00:20:55

knowledge and the people to implement.

Amina: 00:20:57

So all of us, we become knowledgeable in various aspects.

Amina: 00:21:01

If you are trained through mentorship, then you should also be able to

Amina: 00:21:05

train others through mentorship, as opposed to the previous school of

Amina: 00:21:09

thought then again, uh, the engagement with our county government again now

Amina: 00:21:15

creates that feeling that they also need to embed this in our budgets.

Amina: 00:21:21

So that in case the equipment that was do supported by a program or by a partner is

Amina: 00:21:27

worn out, then we need to have in our work plans, a system that is able to replenish

Amina: 00:21:34

the same so that we don't stall because a partner has not come in to support us.

Lucy: 00:21:39

I think it's really the program is, uh, from your explanation is really

Lucy: 00:21:42

coming out to, you mentioned about interventions of this program, how will

Lucy: 00:21:47

these interventions benefit the health service providers, the communities

Lucy: 00:21:52

and also the policy makers, how will those interventions benefit them?

Fatuma: 00:21:55

Okay.

Fatuma: 00:21:56

The benefits to the healthcare provider is this healthcare provider now will have

Fatuma: 00:22:01

self esteemed since he or she has been trained, she has been doing mentorship

Fatuma: 00:22:08

and somebody has been supervising her.

Fatuma: 00:22:10

This healthcare will worker will have confidence in the management of maternal,

Fatuma: 00:22:15

newborn, postnatal and antenatal care and HIV and in the event he has,

Fatuma: 00:22:22

or he, or she has some doubts, they normally consult the mentors or ourself.

Fatuma: 00:22:29

The community also, they will see the mothers have been managed well, because

Fatuma: 00:22:35

if a mother has gone to a health facility and she has complained of headache

Fatuma: 00:22:40

and some signs of high blood pressure.

Fatuma: 00:22:42

If this healthcare worker has not been mentored or trained on the signs and

Fatuma: 00:22:46

the, or signs and symptoms and the management of eclampsia, uh, he, or

Fatuma: 00:22:51

she might say the mother has malaria or any other thing, this mother might

Fatuma: 00:22:56

be mismanaged and goes back home.

Fatuma: 00:22:58

But this is the healthcare worker whom, who, whom have been trained and

Fatuma: 00:23:02

capacity built on the management of a patient with, uh, a eclampsia or

Fatuma: 00:23:08

preeclampsia he or she will manage.

Fatuma: 00:23:11

Now we will have a reduced number of maternal complications and

Fatuma: 00:23:16

in the long run, it'll improve maternal quality care and reduce

Fatuma: 00:23:21

maternal mortality at our county level and our health facility level.

Fatuma: 00:23:27

And now the community will see at least that facility or that county, uh, at least

Fatuma: 00:23:32

the staffs are, are competent in managing maternal and newborn complications.

Fatuma: 00:23:39

And in the long run this now reproductive maternal and, uh,

Fatuma: 00:23:45

newborn indicators in the country.

Lucy: 00:23:48

Do you have a challenge you anticipate when implementing this

Lucy: 00:23:51

program at capacity building level for healthcare providers, maybe even

Lucy: 00:23:56

at community level, maybe at policy level, are there anticipated challenges?

Amina: 00:24:00

I think for us, the challenge is basically I would look at competing tasks

Amina: 00:24:07

because, uh, which still goes back to the, uh, inadequate number of human resource.

Amina: 00:24:13

Sometimes when you want to engage, you find there is so much,

Amina: 00:24:18

and the clientele is that big.

Amina: 00:24:20

So sometimes you don't really get enough time to really engage with the mentees

Amina: 00:24:27

you did expect, that can be a challenge.

Amina: 00:24:30

Then I am just also seeing a scenario where the turnover might

Amina: 00:24:35

affect the management as well.

Amina: 00:24:37

And sometimes depending on the, uh, area of interest, then the management that is

Amina: 00:24:42

brought in is not really in support and issues like the political environment.

Amina: 00:24:47

Again, uh, you know, some of these posting and staff changes

Amina: 00:24:51

are also politically instigated.

Amina: 00:24:53

So those can also be a, a problem in terms of ensuring sustainability

Amina: 00:24:58

for, for the program, uh, where the equipments that we use are worn out again.

Amina: 00:25:05

That can probably also because, uh, the participatory approach requires

Amina: 00:25:10

some of the few equipments that we use for demonstration before

Amina: 00:25:13

we go to the actual patients.

Amina: 00:25:15

But I think all in all, uh, With the proper engagement and continuous support

Amina: 00:25:23

supervision for the mentorship as well.

Amina: 00:25:26

And the management engagement, we should be able to, uh, continue.

Lucy: 00:25:32

Fatma for those, uh, aspect, um, uh, just came to my mind in

Lucy: 00:25:37

terms of the challenges that you're mentioning, staff turnover, you

Lucy: 00:25:40

know, the issues of overload.

Lucy: 00:25:42

This program is covering just a fraction of, the facilities, is

Lucy: 00:25:47

there a, a possibility that through, you know, technical working groups,

Lucy: 00:25:51

facilities that are not directly being supported can utilize the

Lucy: 00:25:56

staff to mentor other facilities?

Amina: 00:25:58

we have that provision and that's why in the mentorship we have the

Amina: 00:26:05

county coordinators are also part of us.

Amina: 00:26:08

And then when they're part of us, they're able to identify the facilities

Amina: 00:26:12

that really need the support of the mentors and organize with the

Amina: 00:26:17

sub county coordinators and then pick a mentor for those facilities.

Amina: 00:26:23

So that is already inbuilt and it is possible.

Amina: 00:26:27

Uh, and it is actually doable and it's we have actually in Vihiga uh, that is part

Amina: 00:26:34

of, uh, an area that we are exploring and we have started working on this.

Lucy: 00:26:38

Thank you very much.

Lucy: 00:26:39

I think I would want to stop there.

Lucy: 00:26:41

I'll give it back to Kims to the next phase over to you Kim.

Kim: 00:26:45

Thank you very much, Lucy.

Kim: 00:26:47

So we've heard a lot about the training that's being done and

Kim: 00:26:50

the mentorship and how the program is going, which is wonderful.

Kim: 00:26:54

From your extended experience a lot of people listening to this podcast

Kim: 00:26:58

are researchers and wanna know how they can work with communities better.

Kim: 00:27:02

Whether that community is the nursing population or human resources for health.

Kim: 00:27:08

What advice would you give them?

Fatuma: 00:27:10

First of all to use the entry points to the county level and, uh, get

Fatuma: 00:27:17

the county management, uh, involvement, don't just go to the facilities without

Fatuma: 00:27:22

the county agreement, have an agreement with the county so the advice I give them

Fatuma: 00:27:28

is pass to have the leadership meeting, then give their, their area of interest.

Fatuma: 00:27:34

They can say, we want to work in that area or that area then before doing anything

Fatuma: 00:27:40

else, uh, they sign an MOU ,that me as an organization, we are going to do B, C, D,

Fatuma: 00:27:48

then the county should do a one to three.

Fatuma: 00:27:51

Then maybe the first thing to start with after they signing the memorandum

Fatuma: 00:27:56

of understanding is to do a baseline assessment to those selected or the

Fatuma: 00:28:03

facilities that they want to work on and know how that facility is performing.

Fatuma: 00:28:09

After getting the go ahead from the county level, at the county level, we

Fatuma: 00:28:14

have the person in charge of the community health units, community health strategy.

Fatuma: 00:28:19

Then we can scale down to the community level, explain to them, in the community

Fatuma: 00:28:24

strategy, we have open days, we are called community dialogue days.

Fatuma: 00:28:29

We can call for the community, like in a meeting outside, it can be in a school

Fatuma: 00:28:35

and at three, or even in the health facility that we are this organization.

Fatuma: 00:28:39

We want to support the implementation of quality of improvement in antenatal

Fatuma: 00:28:45

and healthcare and HIV program.

Fatuma: 00:28:48

Uh, so that you also know the demand of the community direct from the their mouth.

Fatuma: 00:28:54

Now this one will be the partners and the ministry of health together.

Fatuma: 00:28:58

We can meet the community and get the words from their own mouth, we have

Fatuma: 00:29:04

common understanding and the deliberations

Kim: 00:29:07

So just building on that, any piece pieces of advice, when you're

Kim: 00:29:11

speaking with communities that can really help to understand their experience.

Amina: 00:29:18

Communication, you need to really understand one thing, which is key is

Amina: 00:29:22

their academic and, uh, educational background is also very important because

Amina: 00:29:28

language barrier can be a very big problem and, uh, if you want to reach them and

Amina: 00:29:33

you are not able to address them in a language that they're able to understand,

Amina: 00:29:38

it can be an impediment in that direction.

Amina: 00:29:41

Sometimes like cosmetics, we may end up talking things that are

Amina: 00:29:45

only understood by ourselves.

Amina: 00:29:47

So we must be able to break our, uh, the issues into simple

Amina: 00:29:51

local people's understanding.

Amina: 00:29:53

Culture is another issue.

Amina: 00:29:55

Uh, if you are the culture you are coming from a background that uh, maybe

Amina: 00:30:00

consider certain words, uh, as very normal, you go to another community.

Amina: 00:30:06

We have several, several dialects, uh, Vihiga is predominantly

Amina: 00:30:11

Luhya, but in Vihiga alone, we are having about four dialects.

Amina: 00:30:15

So, and one word dialect may have a word that means an

Amina: 00:30:20

obscenity in another, uh, dialect.

Amina: 00:30:23

So you really need to understand the language and also the

Amina: 00:30:26

culture and connotation.

Amina: 00:30:27

There are those groups that will even want, uh, to carry like their

Amina: 00:30:31

placenta back, home and bury.

Amina: 00:30:34

So they, they are quite a number of cultural issues that we need to understand

Amina: 00:30:39

as we come to, to engage with them.

Amina: 00:30:42

You go to other communities, they don't really expect women to, to

Amina: 00:30:46

address certain issues with men.

Amina: 00:30:49

So those are things that we may need to also consider as, uh,

Amina: 00:30:53

we want to engage with them.

Amina: 00:30:56

And, and, uh, more importantly, the male involvement in this community

Amina: 00:31:00

is very key because they're the holders of the economy of the family.

Amina: 00:31:05

So again, uh, if you don't engage the man, most of the times and more, or

Amina: 00:31:10

so the, the mothers in law also have a say, then sometimes if you address

Amina: 00:31:14

the, the women who are still in reproductive age alone, then you are

Amina: 00:31:18

not able to really get to the problems.

Amina: 00:31:21

Thank you very much for the, that advice really important is, uh,

Amina: 00:31:25

considering language, education, culture, beliefs, and, uh, different

Amina: 00:31:30

power dynamics in the families as well.

Amina: 00:31:32

So thank you for that.

Amina: 00:31:33

And that's a wonderful place to end this episode.

Amina: 00:31:36

So thank you very much to our guests for joining us and sharing their

Amina: 00:31:39

wonderful insight and experience.

Amina: 00:31:41

Thank you to Lucy, our co-host who has been great as always.

Amina: 00:31:46

And, uh, finally thank you to our listeners.

Amina: 00:31:48

Once again, please do light share, rate and subscribe so we

Amina: 00:31:52

can continue to learn from these valuable insights across the world.

Amina: 00:31:57

Thank you listeners, and, uh, see you next time.

Amina: 00:32:00

Goodbye everyone.