TURKANA MNCH PROJECT

1. TURKANA MNCH PROJECT Dr I.N. Mwangi MBCHB, MSC ( PAEDS) Project Officer, Turkana West MNCH Consortium For National health Research (CNHR) Africa medical and Research Foundation ( AMREF)

2. THEME OF MNCH PROJECT • To Support to provide mother and child health, nutrition and family planning services in arid and semi arid lands in Kenya PARTNERS • AMREF • CNHR • EU • MOH/ TURKANA COUNTY GOVT

3. INTRODUCTION • Kenya is yet to achieve MDG 4 and 5 • Pastoral and semi- pastoral arid areas are worst affected • Turkana county is among the worst affected areas in Kenya ( see table) • There is need for multi sectoral approach and evidence based best practices to address this problem

4. CURRENT MNCH STATISTICS IN STUDY AREA

5. BASELINE SURVEY FINDINGS • ANC visit– 64.6% • Health facility delivery- 19.9% • PNC visit- 34.1% • Family planning use- 8.9% • Full immunization- 28.1% • Vit A supplementation- 49.5% • Severe malnutrition in children- 10.2% • Moderate malnutrition in children- 21.8%

6. Conclusions of Baseline Survey • Delivery of basic, maternal, newborn and child healthcare services is far from adequate • Access to quality maternal and child health services remains very low due to a number of factors including; • long distances to reach the few available health facilities • the perceived inadequacy of services in public health facilities, • perceived indifferent attitude amongst health care providers • economic constraints at the household level. • inadequate access to correct information on FP and immunization coupled with deep harmful traditional beliefs • established practice of home delivery and early marriages with those having escaped the ritual being disadvantaged by stigma and discrimination.

7. Recommendations • Promoting delivery in health facilities attended by skilled health care providers • There is need to promote uptake of FP • Promote Improved Access by use of innovative approaches that will enhance MNCH-RH service delivery, accessibility and quality • Need to strengthen MNCH-RH services in existing health facilities • Community Health Services: There is also need to ensure that the community strategy is fully rolled out

8. Recommendations (cont’d) • Extensive promotion of Immunization • Promote of Partnerships with and build capacity of Community Based Organizations • Address the Gender Inequality and harmful cultural practices and beliefs such as early/forced marriages: • Operationalize the Youth Friendly Services: • Promote community systems and engagement for effective mobilization and greater reach. • Women Empowerment.

9. THE NGADAKARIN BAMOCHA MODEL This is aimed at improving MNCH in Turkana west The Key components are: • Training of CHW on prevailing diseases, and MNCH • Provision of drug kits for treatment of minor ailments • Establishment of container clinics along the migratory routes • Establishment of pilot maternity waiting homes • Operations research ( evidence based impact of the model)

10. Following the baseline survey results the following are expected: Increased awareness and utilization of maternal and child health services. Increased awareness and strengthened delivery of nutritional services. Improved acceptability, access and uptake of family planning services. Strengthened capacity and referral linkages between communities and health facilities. Evidence based best practices of pastoralist community based health interventions documented ( Operations Research) Expected Outcomes of the NGB Model

11. ACTIVITIES INVOLVED IN THE MODEL • Training health workers on aspects of MNCH eg BEMONC, IMCI, FANC, NUTRITION, FP • Train 300 CHW on key MNCH topics and support A/CHWs on community Health Education on MNCH • Conduct Monthly mobile outreaches for MNCH services • Involve and engage men, traditional leaders, elders, traditional health practitioners in women’s right • Pilot the use Maternity Waiting Homes (MWH) for the provision of routine ANC, skilled delivery and PNC • Train 4 CBOs & representatives of women groups to advocate on right to health of women, newborn and children

12. ACTIVITIES (CTD) • Support DHMT • Support health facilities • Support quarterly Community Dialogue Days in 6 Community Units and 9 Adakar Community Groups with a focus on MNCH and nutrition • Support behavior change activities to address MNCH • Support DHMT with nutritional outreach services and regular micronutrient supplementation and de-worming campaigns • Develop culturally acceptable IEC materials on nutrition, FP,

13. MATERNITY WAITING HOMES • Piloting 2 MWH is part of the activities to be undertaken in this model • MWH provide a setting where high risk women can be accommodated during the last weeks of pregnancy near a health facility with Comprehensive Emergency Obstetric an Neonatal Care (CEMONC) • It is a strategy encouraged by WHO and has been tried in many countries particularly in Asia • They bridge the ‘GEOGRAPHICAL GAP’ in obstetric an neonatal care in hard to reach areas CRUCIAL ELEMENTS OF MWH • They do not require high technology • They rely on already present human resources • Serve in a practical way to meet needs of pregnant women • Provide a link with other available comprehensive care services • THE MOST IMPORTANT ASPECT OF MWH IS TO IDENTIFY HIGH RISK PREGNANCIES AND PLAN FOR THEM!!

14. ESTABLISHING A MWH Start by doing a NEEDS ASSESSMENT of EMONC in a geographical area Focus on the following : • Availability • Accessibility • Quality Selection of a location:- • Only in a remote inaccessible area. • Within the compound of a hospital/HC • At least 2 mid wives, services 24/7 • Can be used for other services eg VCT/PMTCT • Skilled staff should be available to facilitate referrals

15. SERVICES AT MWH Ideally a MWH should have the following: 1.Heath services • ANC • Maternity services • Basic Clinical Services • Referral • Ambulance • Health Education • Food • Child care • Others e.g. income generating activities

16. MONITORING AND EVALUATION • Daily activities • Admissions • Referrals • Pregnancy outcomes • Compare situation before and after MWH • Cross comparison with areas with no MWH • Health status indicators eg maternal mortality ratio, • Neonatal mortality ratio • Use of services In our case M/E will be incorporated in the OPERATIONS RESEARCH

17. Operations Research on the NGB Model • Operation research can improve health outcomes • provide evidence to inform policy • Identify cost effective interventions • Create awareness • Measure impact of intervention • Determine cost effectiveness • A SUCCESIFUL OPERATIONS RESEARCH SHOULD HELP DECISION MAKERS MAKE INFORMED DECISIONS. THIS IS OUR MAIN TARGET IN THE OR WE WILL CONDUCT ON THIS MODEL

18. Decision Making = choosing among alternatives The product of decision makers Choices will be made with or without analysis Key pillars of analysis Helping the decision maker understand problems and candidate solutions Ensure adequate range of alternatives Establish meaningful measures Define issues/ questions Ensure trackability/ traceability The foundations of credible analysis Tools, techniques, and infor-mation surrounding the art of timely, informative support to decision makers Objective / Question Analyst (analysts, scientists, engineers, etc) Models (analytical, simulations, etc.) Data / Assumptions How to establish priorities In Operations Research

19. OPERATIONS RESEARCH PLAN • Find out what the problem is • Consider possible causes of the problem • Consider possible solutions • Develop protocol to address the above • Collect data • Analyze Results • Disseminate results • Suggest solutions • Implement • Use information to assist in decision making

20. THANK YOU!!!