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Walking Together: Towards a Collaborative Model for Maternal Health Care in Pastoralist Communities of Laikipia and Samburu, Kenya

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Abstract

Purpose In 2009 the Kenyan Government introduced health system reforms to address persistently high maternal and newborn mortality including deployment of skilled birth attendants (SBAs) to health facilities in remote areas, and proscription of births attended by traditional birth attendants (TBAs). Despite these initiatives, uptake of SBA services remains low and inequitably distributed. This paper describes the development of an SBA/TBA collaborative model of maternal health care for pastoralist communities in Laikipia and Samburu. Description A range of approaches were used to generate a comprehensive understanding of the maternal and child health issues affecting these pastoralist communities including community and government consultations, creation of a booklet and film recognising the contributions of both TBAs and SBAs that formed the basis of subsequent discussions, and mixed methods research projects. Based on the knowledge and understanding collectively generated by these approaches we developed an evidence-based, locally acceptable and feasible model for SBA/TBA collaborative care of women during pregnancy and childbirth. Assessment The proposed collaborative care model includes: antenatal and post-natal care delivered by both SBAs and TBAs; TBAs as birth companions who support women and SBAs; training TBAs in recognition of birth complications, nutrition during pregnancy and following birth, referral processes, and family planning; training SBAs in respectful maternity care; and affordable, feasible redesign of health facility infrastructure and services so they better meet the identified needs of pastoralist women and their families. Conclusion The transition from births predominantly attended by TBAs to births attended by SBAs is likely to be a gradual one, and an interim SBA/TBA collaborative model of care has the potential to maximise the safety of pastoralist women and babies during the transition phase, and may even accelerate the transition itself.

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Acknowledgements

Mothers’ Union of the Anglican Church Kenya Diocese of Mt Kenya West, Health Ministries of Laikipia and Samburu counties, Pamela Onyo, Lillian Piroris, and John Ole Tingoi. This study was funded by the Australian government’s Department of Foreign Affairs and Trade. The views expressed are those of the authors and not necessarily those of the Commonwealth of Australia.

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Authors and Affiliations

  1. Nossal Institute for Global Health, University of Melbourne, Level 4, Alan Gilbert Building, 161 Barry St, Carlton, VIC, 3010, Australia

    Michelle Kermode, Alison Morgan, Tanya Caulfield & Matthew Reeve

  2. Amref Health Africa, PO Box 27691-00506, Nairobi, Kenya

    Josephat Nyagero & John Nduba

  3. Mother’s Union of the Anglican Church Kenya, Diosece of Mt Kenya West, PO Box 229, Nyeri, Nyeri County, 10100, Kenya

    Florence Nderitu

Authors
  1. Michelle Kermode
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  2. Alison Morgan
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  3. Josephat Nyagero
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  4. Florence Nderitu
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  5. Tanya Caulfield
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  6. Matthew Reeve
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  7. John Nduba
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Correspondence to Michelle Kermode.

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Kermode, M., Morgan, A., Nyagero, J. et al. Walking Together: Towards a Collaborative Model for Maternal Health Care in Pastoralist Communities of Laikipia and Samburu, Kenya. Matern Child Health J 21, 1867–1873 (2017). https://doi.org/10.1007/s10995-017-2337-5

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  • DOI: https://doi.org/10.1007/s10995-017-2337-5

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