A framework to improve postnatal care in Kenya

[摘要] English: More than half a million women encounter complications during childbirth annually witha significant number of fatalities (UNFPA 2009: Online). It is estimated that 1,000 girlsand women die in pregnancy or child birth each day (The White Ribbon Alliance 2010:Online; Ashford, Wong and Sternbach 2008:457-473). Ashford et al. (2008) further statethat almost 40% of women experience complications after delivery with about 15% ofthese women developing potentially life-threatening complications.Maternal mortality can occur either during the antenatal, intrapartum or postnatal period.However, strategies to reduce maternal mortality have focused on the antenatal and theintrapartum periods (Ministry of Health, Kenya 2006: 52). Maternal mortality can bereduced with improved postnatal care by skilled health care professionals , the majorityof whom are the midwives in many low and middle income countries (Senfuka 2012:Online; UNFPA 2011c: Online). Maternal mortality is greatest during the postnatalperiod which remains the most neglected stage of maternal care especially in the LMICsKenya included (Safe motherhood 2011: Online).The aim of this study was to develop a Framework to improve postnatal care in Kenya.The study was accomplished in three phases whereby the first objective was todetermine factors contributing to the current state of postnatal care services in Kenyawhich was undertaken in Phase 1.This objective was achieved through data collectionwhere by 258 midwives completed a self-administered questionnaire plus a checklistused in 37 hospitals to assess the availability of physical resources required in theprovision of postnatal care. Data analysis revealed that shortage of midwives exists inall the hospitals utilised for the study with a nurse midwife ratio of more than 10. It wasfurther observed that midwives received incomplete orientation on being posted to thematernity units/postnatal wards hence their inability to provide quality postnatal careservices. Policies and guidelines were reported to be inaccessible by a majority of the midwives and that cultural and religious beliefs of clients were deemed to have someinfluence on the provision of the postnatal care.The Nominal Group Technique was used among 13 Reproductive health coordinators inphase 2 to identify the strategies they deemed if employed would improve postnatalcare in Kenyan hospitals.The six strategies identified in order of priority are capacitybuilding, data management, quality assurance, human resource management,supportive supervision and coordination of postnatal care activities. The objective of thisphase of study was achieved as the NGT process was followed scientifically and resultsobtained (the strategies) contributed to the development of the Framework as one of theimportant components of The Theory of Change Logic Model.The third objective and final phase of the study was to develop a Framework to aid inimproving postnatal care in Kenya. Development of the framework was accomplishedby triangulating the results obtained from Phases 1 and 2. The Framework developmentwas guided by the Theory of Change Logic Model which describes the casual linkagesthat are assumed to occur from the start of the project to the goal attainment (Frechtling2007: 5; Taylor-Powell and Henert 2008: 4). The components of the Theory of Changelogic by Kellogg (2004: 28) are the problem or issue, community needs, desired results,influential factors, strategies and assumptions (Kellogg 2004: 28). The draft Frameworkwas presented to the Reproductive Health coordinators for validation in a meeting heldon 12th March 2014. The stakeholders who are the Reproductive Health coordinatorsadded their expert input to the components of the Theory of Change Logic Model duringthe validation process leading to a complete Framework aimed at improving postnatalcare in Kenya.

[发布机构] University of the Free State