NAIROBI, March 13 (IPS) – Until 2019, nurses at three health facilities in Kenya’s semi-arid southeast region of Makueni County struggled to bring critical health services closer to a hard-to-reach population spread across three remote, remote villages.
“Kamboo, Yindalani and Yiuma Mavui villages are 17 and 28 kilometers from Makindu sub-county hospital, and 10 and 22 kilometers from the nearest electricity grid,” Benson Musyoka, nurse in charge of Ndalani dispensary in Yindalani village told IPS.
Without a cold chain capacity to store essential vaccines and drugs, health facilities show that vaccination coverage across these villages was well below 25 percent.
Babies were born at home because mothers couldn’t raise the $6 to $12 to hire one boda boda or motorbike taxis, which are the only means of transport in the area. Others could not reach the hospital in time to give birth.
“Every morning I collected vaccines at Makindu sub-county hospital and transported them in a vaccine box to Ndalani dispensary. Once the vaccines are inside the carrying box, they are only viable for up to six hours, at which point any doses that remain unused must be returned to stored at Makindu sub-county hospital for refrigeration or thrown away, says Musyoka.
In February 2019, a ground-breaking donation of a solar-powered freezer to Kamboo’s health center significantly improved the accessibility and availability of vaccinations and maternal health services in the three villages and surrounding areas.
Francis Muli, the nurse in charge of Kamboo’s health center, tells IPS that without a refrigerator or freezer, “you can’t store oxytocin, and without oxytocin you can’t provide labor and delivery services.”
He says it would be extremely dangerous to do so because Oxytocin is injected into all mothers immediately after giving birth to prevent postpartum hemorrhage. Oxytocin is also used to induce labor.
As recommended by the World Health Organization, Oxytocin is the gold standard for preventing postpartum hemorrhage and is central to Kenya’s ambitious goal of zero preventable maternal deaths.
In 2017, the Ministry of Health identified substandard care in 9 out of 10 maternal deaths due to postpartum haemorrhage. Overall, postpartum hemorrhage accounts for 25 percent of maternal deaths in this East African nation.
Usungu dispensary and Ndalani dispensary are each 10 kilometers from Kamboo health center in different directions. Nurses in charge of the facilities no longer make the long journey of another 28 kilometers and another 28 kilometers from Makindu to collect and return unused vaccine doses on vaccination days.
“We collect vaccine doses from Makindu sub-county hospital at the beginning of the month and store them in the freezer at Kamboo health centre. The freezer is big enough to store thousands of different vaccine doses collected from the county hospital for all three facilities,” said Antony Matali, the nurse in charge of Usungu dispensary in Yiuma Mavui village.
Two to three times a week, Matali and Musyoka collect doses of various vaccines, including all the usual routine vaccines, with the exception of yellow fever. The vaccines are transported to their respective pharmacies in a carrier box that holds up to 500 doses of different vaccines, including the covid-19 vaccines. All three facilities have noted a significant improvement in immunization coverage from a low of 25 percent.
At Kamboo health center, where the freezer is based, data shows that the measles vaccination rate has exceeded the target of 100 percent to include additional clients outside the catchment area by 4,560 people. The total vaccination coverage is at 95 percent, well above the government’s target of 90 percent.
At Ndalani dispensary, the measles immunization rate has also surpassed the target of 100 percent as additional patients, or transit patients from four surrounding villages and neighboring Kitui County, are being served at the dispensary. The overall vaccination rate for all standard vaccines is 50 to 65 percent.
In the Usungu dispensary, the vaccination rate for measles is 75 percent, and for other vaccines the coverage is 50 percent.
“Usungu and Ndalani have not reached the 90 percent mark because we suffer from both missed opportunities and defections. Missed opportunities are patients who stop by a facility looking for a service and find that it is not available at that particular moment. Dropouts are those who feel inconvenienced if they do not find what they need on their subsequent visits, so they drop out along the way,” explains Musyoka.
A cold chain or storage facility like the solar-powered freezer, says Muli, is the cornerstone of all cash-strapped rural primary health care units, and all services related to mother and child are the cornerstones of all health facilities. Without these services, he points out, all you have is brick and mortar.
“At Usungu and Ndalani we currently do not offer labor and delivery services because we do not have Oxytocin in the facility at all times due to lack of storage, and we cannot carry it around hoping for a delivery that day due to the six-hour period,” explains Musyoka.
Pregnant women still receive the usual tetanus shots and all other prenatal services, but close to the delivery period, Ndalani and Usungu refer the women to Kamboo’s health center and follow-up to ensure they receive referral services. Facility records show zero infant and maternal mortality.
Annually, the Ministry of Health aims to vaccinate at least 1.5 million children against vaccine-preventable diseases such as measles, polio, tuberculosis, diarrhea and pneumonia. Currently, one in six children under one year of age do not complete their scheduled vaccines.
Only one in two children under the age of two has received the second jab of measles-rubella, and only one in three 10-year-old girls has received two doses of the HPV vaccine that protects against cervical cancer.
Ongoing efforts are helping to address these gaps. For example, the HPV vaccine was introduced in Makueni in March 2021. Musyoka vaccinated 46 girls aged 10 years with the two doses of HPV vaccine in 2021, and another 17 girls received their first HPV dose in 2022 and are due for the second dose in November 2022 .
Healthcare providers say the freeze has transformed the delivery of maternal and child services in the area by bringing critical immunization services closer to a marginalized and highly vulnerable community.
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