ACCELERATION OF MATERNAL, NEWBORN AND CHILD SURVIVAL IN KENYA
Setting a national agenda-March 2010
Background
Kenya has recently registered encouraging improvements in child survival indicators
over the period 2003-2008/9. On the other hand, we hardly made any progress with
maternal neonatal health and nutrition indicators over the same period. The preliminary
Kenya Demographic Health Survey (KDHS) 2008/9 showed reductions in Infant Mortality
Rate (IMR) from 77 per 1000 live births in 2003 (KDHS 2003) to 52 per 1000 live births in
2008/9. The Under Five Mortality Rate reduced from 115 to 74 per 1000 live births over the
same period of time. It is thought that the improvements seen in child survival during that
period could be explained by the scale up of high impact evidence based interventions such
as Insecticide Treated Nets (ITNs), Artemisinin Combination Therapy (ACTs) and Vitamin A
supplementation
The neonatal mortality rate only reduced marginally from 33 to 31 per 1000 live
births between 2003 and 2008/9. Only 43 percent of women were delivering in health
facilities by 2008/9 (KDHS, 2008/09). Over the same period exclusive breastfeeding rates, 05 months, increased from 13% to 32% and at 6 months from 3% to 13%. However this was
noted to be still way below the target. Nutrition related indicators continue to show
significant regional disparities with the arid and semi arid areas showing high levels of
stunting. The national average distances to domestic water points have increased to 25-30
km against the normal of 7 kms. This has had a corresponding effect on the quantity of
water available for domestic use with the average down to less than 5 litres per day
compared to the recommended 5-10 litres per day (KFSSG 2009). Only 42 percent of the
population has access to a safe drinking water supply and 46 percent has safe sanitation in
20071 while handwashing is very low despite their importance in the prevention of
diarrhoea and neonatal sepsis.
12007
WHO UNICEF Joint Monitoring Program
Setting the Agenda for Accelerating Maternal, Newborn and Child survival
A national stakeholder’s workshop on acceleration of maternal, newborn and child
survival was convened by the Ministry of Public Health and Sanitation in March 2010. The
workshop achieved consensus on the following outcomes:
1. Prioritization of selected high impact interventions for maternal, newborn and child
survival and,
2. Identification of cardinal actions, commitments and timelines which stakeholders
will implement towards the acceleration of maternal, newborn and child survival.
Table 1: Priority High Impact Interventions by Level of Care, Cohort and
Intervention Area
Community- L1
Facility level- L2, L3, L4

Demand creation for early
initiation of ANC
Individualised birth plan
and Emergency
preparedness

Community actions to
promote skilled care







BCC for FP, PNC, Newborn
and child care practices
BCC to promote skilled
attendance with first 24-48
hours after delivery
Hygienic cord care
Newborn temperature
management
Hand washing with soap
by caregiver


Four timely focused ANC visits with a focus on:
o Individualised Birth Plan and Emergency Preparedness
o Prevention and management of pregnancy
complications
( IPT, iron and folate, TT, PMTCT, MgSO4,
micronutrients)
Emergency Obstetric Care- Administer IV oxytocin, IV
antibiotics, Magnesium sulphate, Manual removal of placenta,
removal of retained POCs, Assisted delivery, Blood transfusion,
and caesarean section
Active management of third stage labour
Monitoring labour using partograph




Skilled attendance within first 24-48 hours after delivery
PNC
Long acting and permanent FP methods
Conduct maternal and perinatal death reviews
Hand washing with soap by caregiver
Temperature management
Antibiotics for neonatal infections
Newborn resuscitation
ARV prophylaxis
Early initiation and EBF
Complementary feeding
Vitamin A
Immunization
LLITN
ORT and Zinc
ACT



Early initiation and EBF
Complementary feeding
Vitamin A












Immunization
LLITN
ORT and Zinc
Safe drinking water








Antibiotics for childhood pneumonia
Early Infant Diagnosis of HIV
ART
Cardinal Actions, Commitments and Timelines for the Acceleration of Maternal,
Newborn and Child Survival
National level
1. The Director PHS will issue a twice yearly bulletin to all stakeholders on new
developments in the health sector such as the Community Strategy, HSSF, HRH, and
Infrastructure Development e.t.c.
2. The Director PHS will convene national annual forum to review progress in
accelerating MNC survival just before commencement of AOP process.
3. The Director PHS will issue a bulletin outlining the cardinal actions, commitments
and timelines for acceleration of Maternal, Newborn and Child survival to all
stakeholders in the health sector as well as in other sectors 1 week after the national
annual review forum for accelerating MNC survival.
4. Programme managers in the Ministry of PHS and partners will include high priority
MNC Child survival in all quarterly Interagency Coordinating Committee meeting
agendas including Commodity and Supplies ICC.
5. The heads of Reproductive Health, Child Health, Nutrition, Hygiene and Sanitation
will conduct partner mapping for MNCH for resource identification and targeting.
6. The heads of Reproductive Health, Child Health, Nutrition, Hygiene and Sanitation
will finalize the MNC survival Road Map using multi-sectoral engagement to clarify
roles and responsibilities.
7. The Director PHS will develop RRI schedule based on high impact interventions for
MNC survival by end of May 2010. The director will build leadership and
management capacity for MNCH (RRI) at national, provincial and district levels.
8. The head of HMIS will review AOP monitoring indicators to include priority high
impact interventions (HII).
Provincial level
1. The Provincial Directors will convene quarterly Provincial Health Stakeholder forum
focusing on acceleration of MNC survival.
2. The Provincial Directors will prioritise selected high impact interventions outlined
above in the AOP 6 process before end of April 2010.
3. The Provincial Directors will conduct partner mapping for MNCH for resource
identification and targeting.
4. The Provincial Directors will initiate onsite supportive supervision in the provincial
hospital and provincial management level.
5. PHMTs will participate in supportive supervision and monitoring of district and other
lower levels.
District Level
1. The DMOs will convene quarterly District Health Stakeholder forum focusing on
acceleration of MNC survival.
2. The DMOs will prioritise selected high impact interventions outlined above in the
AOP 6 process before end of April 2010.
3. The DMOs will conduct partner mapping for MNCH for resource identification and
targeting.
4. The DMOs will initiate onsite support supervision in the District hospital and District
management level.
5. DHMTs will participate in supportive supervision and monitoring of health centres,
dispensaries and community while specifically focussing on completeness of HMIS at
all levels.
6. DHMT, District Accountant and District Internal Auditor will monitor the
implementation of HSSF at level 1, 2, and 3.
7. Strengthen FTP HMIS
Level 2, 3, 4 – Health Facilities
1. The facility I/C will initiate onsite supportive supervision in their respective facilities.
2. I/C to coordinate Planning and implementation of selected priority high impact
interventions for the level of care as shown in table 1 above.
3. I/C will oversee HSSF implementation at Level 2 and 3
4. I/C will maintain up to date HMIS and up load to central server through file transfer
protocols.
Level 1-Community
1. The CHEW will coordinate planning and implementation of priority high
interventions at the community as shown in table 1 above.
2. CHEWs to initiate onsite supportive supervision at the community level.