Effectiveness of Ng’adakarin BAMOCHA model
in improving access to ante-natal and delivery
KIBERA INTEGRATED HEALTH SERVICE
services
among
nomadic pastoralist communities
DELIVERY
MODEL
of Turkana West and Turkana North subCounties of Kenya
Jillo Ali Jillo, Peter Ofware
AT THE AMREF HEALTH INTERNATIONAL CONFERENCE
November 2014
AREA BACKGROUND AND
DEMOGRAPHICS
 Turkana North and Turkana West of Turkana county with
estimated area of 35,000km2.
 Estimated population: 250,760
 Women of childbearing age: 54,530.
 Under 5s: 34,615.
 80% of the population are Nomadic pastoralists
INTRO: NG’ADAKARIN BAMOCHA
MODEL
 Ng'adakarin: Migratory groups
 Based on migratory routes of nomadic pastoralists of
Turkana.
 Has three main components:
o Services at container clinics
o Improved referral systems
o Modified (fluid) community health units
MAPPED MIGRATORY ROUTES
MAPPED MIGRATORY ROUTES
CONT’D
PROBLEM STATEMENT
 Ng’adakarin BAMOCHA brings together health care at the
facility level and a strong community based component
 Aim: community access and are actively involved in the
improved delivery of essential health interventions.
 Migratory lifestyle places the community outside
conventional static health systems
 Specifically targets four key maternal and child health
indicators:
(i) ante-natal care (ii) skilled delivery
(iii) family planning (iv) immunization
PROBLEM STATEMENT CONT’D
 Focused Research- Empirical evidence of effectiveness
missing.
 Health road map for Turkana (2007) stakeholders to base
HSP on Ng’adakarin BAMOCHA model.
 Effectiveness of Model study necessaryo Accountability for donor and County Government
funding
o Health of 80% of Turkana Population at stake
RESEARCH QUESTIONS AND
OBJECTIVE
Questions

NB model on access to 4th antenatal care

NB model on access to delivery under skilled care
Objective
To evaluate the effectiveness of the Ng’adakarin BAMOCHA
model in improving access to maternal and child health care
services among nomadic pastoralists of Turkana North and
West sub-Counties
METHODS
 Sample size: 384 women (Cochran’s formula)`
 Data collection tools: HH questionnaire, FGD guide, KII
guide
 Data entry: Ms access
 Data analysis: SPSS version 21 and Nvivo version 10
DEMOGRAPHICS
Age
15-19 years
20-24 years
25-29 years
30-34 years
35-39 years
40-44 years
45-49 years
Mean
Std. deviation
Education
None
Primary
Secondary+
Not stated
Demographic
Christians
Muslim
Traditional
Other
Not stated
Number
Pre-intervention Post-intervention
%, N= 382
%, N=400
Independent samples
T-test (p-value)
2.8
20.8
25.3
30.3
10.8
8.3
1.9
28.05
4.9
7.9
28.6
24.3
16.8
11.6
6.1
4.8
28.45
4.8
0.13
90.8
4.7
3.1
1.4
86.6
9.3
2.0
2.0
0.15
80.6
0.6
13.6
1.9
76.8
1.1
9.5
1.4
0.15
3.3
360
0.9
441
ANTE-NATAL CARE
Number
Pre-intervention
Post-intervention
Frequency (%)
Frequency (%)
Once
33 (14.3%)
32 (12.1%)
0.12
Twice
31 (13.4%)
65 (24.5%)
0.02*
Three times
42 (18.2%)
57 (21.5%)
0.05*
Four times
119 (51.5%)
111 (41.9%)
0.04*
Not stated
6 (2.5%)
-
-
Significant at 0.05 - * Significant at 0.01 - ** Significant at 0.001 - ***
p-value
KNOWS ABOUT ATTENDING ANC
4+ TIMES
DISCUSSION
 4th ANC care access similar to national average, KDH
2009
 Trend of dip in ANC uptake and pattern similar to national
pattern, KDHS 2003 and 2009
 Level of education influences uptake of ANC
 Gaps exists between level of knowledge on service and
uptake
Place of Last Delivery
Place of Delivery
Pre-intervention
N(%)
Postintervention
P-value
N (%)
Home
317(89.5%)
318(79.5 %)
0.04*
Away from home
15(4.2%)
10(2.5%)
0.12
Health facility
22(6.2%)
66(16.5%)
0.03*
-
5(1.3%)
-
Other/Not stated
Significant at 0.05 - * Significant at 0.01 - ** Significant at 0.001 - ***
Assistance During Delivery
Assistance
Pre-intervention
N (%)
Post
intervention N
(%)
P-value
Skilled attendants
(Midwife/Nurse/doctor)
20(5.6%)
65(17.7%)
0.03*
TBA
27(7.5%)
74(20.2%)
0.03*
Relatives/friends
142(39.4%)
168(46.0%)
0.06
Self
162(45.0%)
59(16.1%)
0.01**
9(2.5%)
-
-
Not stated
Significant at 0.05 - * Significant at 0.01 - ** Significant at 0.001 - ***
DISCUSSION
 Skilled delivery below national average, KDHS 2009
 Increase in TBA assisted delivery cause for concern;
direct delivery vs referral agents
 Preference for TBA assisted delivery- geographical
access, capacity of C/clinics, costs involved.
CONCLUSION
Improvement in access to and utilization of the targeted
health care services:
 Antenatal care: Significant impact
 Skilled delivery: Significant impact
RECOMMENDATIONS
 ANC- ACHWs involvement and capacity building
o Cross-cutting: Girl child education; mobile schools
and boarding facilities
o Container clinic: Existing container clinic; medical
supplies
 Deliveries: provision of maternity waiting homes
FURTHER RESEARCH
RECOMMENDATION
 Cost effectiveness study of the Ng'adakarin BAMOCHA
model
ACKNOWLEDGEMENTS

European Commission

Big Lottery Fund

Turkana North and West sub Counties communities and
Health Management Teams
THANK YOU