Improving Maternal Health Measurement: A National Dialogue in Kenya
By Angela Nguku, Executive Director, WRA Kenya
On 27th July 2018, White Ribbon Alliance Kenya hosted the first national dialogue in Nairobi, Kenya for the Improving Maternal Health Measurement Capacity and Use (IMHM) project. Done in partnership with the Kenya Ministry of Health, FCI program of MSH and the Women and Health Initiative (W&HI) of the Harvard Chan School of public health – on behalf of the EPMM working group – this is the first of several national dialogues taking place around the world.
The one-day workshop was attended by a wide-range of maternal health stakeholders in Kenya, including representatives of the Ministry of Health, county governments and the county first ladies’ forum, development partners, professional bodies, community groups, and research institutions. Participants were multisectoral in nature representing the health, academia, research, media, gender and economic sectors.
Specific objectives included: to understand Kenya’s priorities relative to the adoption of emerging indicators for ending preventable maternal mortality (EPMM) as part of the country’s maternal and newborn health monitoring framework; prioritize core Phase II EPMM indicators that stakeholders would like to see tested through the IMHM project; identify key priorities related to the additional Phase II EPMM indicators for further development by the IMHM project; and determine advocacy opportunities to elevate the EPMM agenda in Kenya, building on the use of robust monitoring data to enhance programmatic and resource related decision-making.
A key highlight of the dialogue was the acknowledgement that maternal mortality remains a heavy burden in Kenya, implying that the country is either not investing in maternal health overall or not investing in the right strategies. This underscored the need to expand traditional measurement efforts, including with new indicators, to provide a more complete picture of the challenges women, girls and their families face relative to maternal health and respond accordingly. The group also identified the need for targeted investments in social accountability efforts and measurements that better reflect what’s important to women to augment the norm to date of measuring what is important to the health and development community.
Participants gained a clear understanding of the EPMM strategies and that they not only apply to the immediate causes of maternal death and disability but aim to address the risk factors that begin long before delivery. These include social determinants such as where a woman lives, her socio cultural and economic status, family dynamics and institutional factors such as national resource allocation, data infrastructure and political accountability for evidence-based programming.
There was also a realization that accountability and evidence are essential in the implementation of policies and review of its current RMNCH policy framework, and it was established that we must ensure that the right indicators are used to measure the whole delivery of RMNCH interventions if different results are to be attained. Participants felt that there was an important research gap in Kenya and recognized the need to include new measurement indicators around multisectoral collaboration, citizen engagement and demand.
The well-attended and participatory dialogue concluded with the identification of concrete steps that are key to elevating the EPMM agenda in Kenya, including the identification of a small group comprised of the MoH, WRA Kenya and FCI-MSH, who will meet to review and prioritize the Phase II EPMM core and additional indicators holistically and provide recommendations back to the wider group. The small group will also identify opportunities to engage with national processes, specifically the UHC panel that is currently collecting public comment. The Ministry of Health committed to working closely with WRA Kenya to also organize small sector-specific groups to meet and review the identified indicators and agree on priority indicators for the country. They also expressed interest in testing and validating the nine core indicators to augment what is being done in the research settings of Argentina, India and Ghana.
As the dialogue came to a close, there was much excitement among stakeholders and a commitment to keep this conversation alive and the momentum sustained to ensure that the key determinants of maternal health find their way to the measurement tools, so that together, we can reach our ultimate goal: that all women and girls in Kenya receive the quality reproductive and maternal healthcare services they need to survive and thrive.