Homa Bay — Homa Bay is implementing an aggressive camapign to improve health outcomes for expectant women and newborns through a county-wide surveillance of deaths reported.
In an effort to reduce maternal mortality, newborn deaths and stillbirths, health staff investigates the cause of every death.
Caroline Adongo, Nursing Director at the Homa Bay County Referral Hospital, told Capital Health carrying out an audit in aevery death seeks to avert any similar occurrence.
"The auditing process is a learning point to our staff," she said.
The County Health Department started to investigate and discuss every maternal death through Maternal and Perinatal Death Surveillance and Response (MPDSR) review meetings.
USAID funds the initiative under the Momentum Country and Global Leadership (MCGL) program.
"We are glad we received mentorship on how to carry-out the review meetings and we have seen fruit bears," Adongo said.
MPDSR does not support human resources in the hospitals in Homa Bay, rather, it looks into the gaps and plugs support by providing health facilities with equipment.
For instance, to arrest perinatal deaths, the initiative flagged inadequacy of phototherapy machines, incubators and oxygen concentrators. MCGL provided the equipement to resolve the deficit.
No fault-finding
Adongo noted health audits do not aim at fault-fidning on health staff but to identify the skills gaps.
Review committee members sit at the sub-county level within seven days whenever a maternal death occurs.
"The people who are in attendance in the review meetings include, the gynecologist, nurse in charge, nurses on duty and those off duty, medical officers, the pharmacists, pediatrician and laboratory team," Adongo said.
Adongo, who has 11 years of service to retirement, said the aim is to at least cut maternal mortality in the county by half and progressively make steps towards eradicating prevetable cases.
In her nursing career, she says, carrying out maternal deaths audit remains her sweet learning moments.
"At MPDSR, we don't shame the health officials, it is all about learning and mentoring the team, not to make that mistake again," she said.
Lilian Okoth, who supports reproductive health services and quality assurance standards at Rangwe Sub-County, and doubles up as Team Lead of the Review Committee at the sub-county said audits had boosted workplace morale.
Okoth, a nurse by profession, leads a committee consisting fifteen members.
"At the Sub-County level, we oversee the audits from the delivery facilities and look at the gaps and come up with solutions," she said.
She receives reports of deaths of pregnant women or newborns within the facilities under her jurisdiction and kick-starts an inquiry. A scientific form triggers an audit.
"We look into what could have [been] done better to save lives," she said.
She and Adongo agree that delays associated with knowledge gaps, a situation county-run health facilities were now overcoming as a result of ongoing mentorships, stood out in most deaths.
Delayed response
Adongo opines that delays often result from complications at the community-level, hesitancy at home before a mother get to the health center, and slow referrals.
"May be there was no ambulance to take this matter up immediately, so when they come here, they are already gasping, we rescue some, some we lose," she said.
The nurses, say, for referrals, they follow up on the first points and summon the officers involved for a review meeting.
"We discussed the case with them, because that was their client but she died at the referral facility, so we involved them to hear from them, the root cause and look at the gaps," said Okoth.
Okoth noted the MPDSR training to the health staff in Homa County at large has recorded improved service delivery to the pregnant women.
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She noted that over the years, many pregnant women who had shunned health facilities in favour of traditional birth attendants had changed opting to seek medical assistance in facilities.
Last year alone, Homa Bay County recorded 39 maternal and prenatal deaths, with hopes of a further reduction in the deaths in the subsequent years owing to MPDRS interventions.
Severe bleeding after childbirth - postpartum haemorrhage (PPH) - the nurses said, remains the leading cause of maternal mortality in the county.
However, through MPDRS, Adongo said they have been able to respond to commodity gaps and blood transfusion is now available at Sub-County hospitals.
She said the team in the MPDRS and MCGL show the sense of having a blood drive and the campaign has mobilized sufficient stock to help pregnant mothers.
"Because PPH is one of the major causes of mortality and definitely leads to perinatal mortality, blood drive [was] a priority," she said.
