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Bamba Hospital Kilifi


Cutting through cultural barriers in Kilifi

KILIFI, Kenya, Sep 22 – It is not uncommon for women in Kilifi to give birth in the hands of Traditional Birth Attendants (TBA’s).

This is mainly because of the long distances to health facilities and deeply entrenched cultural beliefs.

A majority of the women here do not use any family planning (FP) methods because of cultural beliefs, myths and misconceptions.

“Some women believe that they will develop high blood pressure or become barren if they use any FP method,” explains Bob Charo, Programs Officer at a local non-governmental organisation known as SCOPE that deals with Reproductive Health services in Kilifi County.

He says this has created large families with an average of eight to 13 children per household putting maternal and child health at risk.

According to the District Health Administrative Officer Odna Lwangu another barrier to uptake of family planning is a “submissive female community” where women can only do what their husbands agree to.

Having many children is considered a sign of wealth by this community.

“Many men do not agree to this (FP) and some women decide to take it in secret when they realise that it is for their good,” he says.

With the major economic activity being charcoal dealing, hunting and livestock keeping poverty levels are very high in the County which has a population of over 1.1 million people.

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This is another major contributor to the low access mothers here have to quality reproductive health services like maternity care and family planning.

To deal with this challenge, a program known as Output Based Approach (OBA) to reproductive health services was introduced to ensure that all mothers especially the poor have access to quality maternity and family planning services.

The OBA project enables poor clients access highly subsidised safe motherhood, family planning and gender based violence services.

“It has a poverty index tool that rates the poverty level of a client,” states Lwangu.

The OBA project is also geared towards achievement of the Millennium Development Goals on Maternal and Child health by 2015.

It is a voucher system where with Sh100, a mother can access all the four recommended antenatal clinics and free delivery services.

A similar amount is charged to access family planning services and the vouchers are valid for one year. Vouchers for Gender Based Violence recovery services are offered for free.

Once a client gets the voucher, they access these health services free and then the facility claims from the OBA project which is run by the government and German development partners.

“The OBA project compensates the (health) facilities for the services provided. Like for family planning services they are compensated Sh1,000 per client,” Lwangu explains.

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He notes that OBA has made the health facilities that are within the project provide mother friendly services to attract more clients because the project pays more than the normal rates.

Some facilities have gone as far as offering food and beverages to mothers coming in for antenatal clinics.

To ensure that mothers take advantage of this project, the health workers have tried to incorporate traditional birth attendants.

“We have held meetings with TBA’s to train them on the need for mothers to go to hospital for delivery,” says Philomena Munga, District Reproductive Health Coordinator.

They also sensitise them on the importance of antenatal visits, Prevention of Mother to Child Transmission of HIV and importance of family planning.

“After all the information is given to them, they understand that they don’t have the capacity to deal with these women, they don’t have the equipment to support them and so they refer them to deliver in the health facilities,” she explains.

The TBA’s are also encouraged to escort expectant mothers to the health facilities.

Although such initiatives offer hope to the many mothers who would otherwise not access quality reproductive health services, the lack of enough health facilities in the County is an issue that they say should be addressed.

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