Child and Maternal Mortality in Kenya

Kenya loses about 64,400 children under five-year-old and 5,500 mothers from preventable and treatable conditions (KDHS, 2022). The major causes of the deaths among the under 5-year-olds remain prematurity, low birth weight, birth defects, pneumonia, diarhoea, HIV, and malaria. 51% of these deaths are due to neonatal causes, with the most prevalent being prematurity (23%), followed by birth asphyxia (15%). Among the mothers, the main causes of death include Postpartum hemorrhage (PPH), eclampsia, puerperal sepsis, obstructed labour & unsafe abortion, with PPH leading at 39%.

 Comparing the current mortality rates against SDG 2030 goals, Kenya is still far from achieving the SDG targets across UMR, NMR and MMR.

Kenya Human Resources for Health (HRH) Specialists Gap

Lack of access to specialized services due to the acute shortage of paediatric subspecialists and nurse midwives is a major contributor to the high mortalities. This is because poor access to the services often results to poor quality of care provided by less qualified staff, poor/late diagnosis, high cost of treatment that is unaffordable and many at times premature deaths.

The few available paediatric sub-specialists work in the private sector and tertiary hospitals mainly in Nairobi, hence creating an even bigger gap in the public sector that serves more than 80% of the patients. A 2019 baseline showed only 12 paediatric sub-specialists across 10 sub-specialties. Similarly, nurse specialists were a handful with <350 mapped across 5 nursing specialties. Overall availability against recommended numbers by specialty was below 10% across the entire country

This situation for the longest has been propagated by various factors including:

• Lack of speciality training programs across the main medical training institutions in the country, thus pushing paediatricians desiring to specialize on to a few scholarship opportunities or on to costly self-sponsored programs abroad.
• Lack of faculty to establish the requisite programs.
• Governments underinvestment in special education
• Mismatch between training strategies & population needs

2024 Areas of Focus

Guided by the four CHAI guiding principles, the strategy for 2024 will involve addressing the gaps across the entire training cascade from selection, training and appropriate redeployment including:

Gaps around selection & training:

a) Lack of an accurate national HRH data register & Dashboard to advice on staffing matters e.g. availability, distribution, demand, supply, capacity (leads to selection & training of the wrong cadres).

b) Lack of training programs in cardiology, oncology, gastroenterology, pulmonology, and nephrology.

c) Lack of various key short courses in KPFP and AT program and gaps in KMTC preservice curricula

d) Poor training infrastructure in the training institutions.

• No ideal simulation labs (manikins, AIR devices) •     
• Logbooks for monitoring training non-existent
• Selection process manual because of lack of a system for application of scholarships

Gaps around post-training practice:

a) Improper redeployment to the wrong facility or wrong departments

b) Lack of multidisciplinary teams to work with the subspecialists (E.g. only 44 neonatal nurses) c)   Lack of requisite paediatric infrastructure for post-training Practice

a.   Special Units: NICU & PICUs (0%), Oncology (15%), General ICU (49%)

b.   Equipment: Feeding pumps for pre-terms (0%), Therapeutic hypothermia machines (1%), BGA (2%), HFNC (19%), Bcpap (21%), Glucometers (43%)

c.   Lab tests: 76.3% (29) of the advanced laboratory tests assessed were not done in >50% of the facilities for post-training practice, advanced tests such as HBA1C expensive.

d) Challenges monitoring post-training impact because specialist indicators are not captured on the KHIS (e.g data for special clinics, average length of stay, number of referral ins in need of specialised care and number of referral outs).