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Find out how we are helping to cut maternal and newborn mortality rates in Kenya.
For GSK’s Dr Lisa Bonadonna, it was meeting a mother called Janet in Kenya’s mountainous Bungoma County that brought home the stark reality of infant mortality.
“When I met her in her hut, she recounted the experience of delivering her stillborn baby. She had been trying to make her way to a clinic 5km away in the middle of the night,” remembers Dr Bonadonna. “I asked her what she did afterwards and she said: ‘I wrapped up the baby and we walked back up to the house.’”
Dr Bonadonna heads the partnership between GSK and Save the Children that’s aiming to save the lives of a million of the world’s most vulnerable children over the next five years through initiatives including developing child-friendly medicines and supporting health worker training. She was in Kenya to see the first steps in the partnership’s ‘Signature Health Programme’, which began in remote Bungoma County, in the far west of the country, last year.
In a country where nearly half of the 44 million-strong population survive on less than $1.25 a day, and one child in 19 dies before their fifth birthday, the programme aims to help reduce maternal and newborn mortality by 21%. Through the programme, the plan is for more than 200,000 pregnant women and 180,000 newborns to have access to quality integrated maternal and newborn health services.
“Historically what we’ve seen under the banner of corporate social responsibility is the private sector taking on the role of donor, saying: ‘Here are some funds.’ Maybe there’s a bit of volunteering that goes in with that, but it’s not really using the core skills of the corporation,” Bonadonna says.
“What’s different about this partnership is that we’re actually using the machinery of GSK, deploying what we do on a day-to-day basis. We’re saying: ‘We know stuff: we know how to develop medicines and vaccines, and we can work with Save the Children to get them to the communities and people who need them.’”
Bungoma County has been ranked third among the counties with the highest contribution to Kenya’s total national child deprivation in a study conducted by UNICEF . The study was designed to identify the counties that contributed most to poor child health indicators nationally.
Postpartum haemorrhage, obstructed labour, infection and eclampsia are the main causes of maternal mortality, while for newborns, it’s prematurity, infection and problems during labour. The quality, affordability and physical accessibility of health facilities are major issues, says Save the Children’s Dr Angela Muriuki, senior programme manager for the Signature Health Programme, but equally important are the impact of cultural and social norms.
A mother-to-be may know the danger signs that mean she should visit a clinic, or may want to give birth there, but often she’s not the one who chooses. “A lot of times you will find that because of the gender dynamics, that decision is taken by her husband or her mother-in-law,” Dr Muriuki says. “If the husband doesn’t think it’s important, she doesn’t go.”
One particularly problematic tradition is the practice of putting cow dung or soil on the stump of the baby’s umbilical cord, providing an easy conduit for infection.
To address these issues, community health workers are being encouraged not just to educate pregnant women, but to speak to husbands as well. Women’s groups that include mothers-in-law are being set up to talk about maternal health, and the programme is working with traditional birth attendants, who are highly respected locally.
“We are trying to co-opt [birth attendants] into encouraging women to use the health facility, then to accompany them there and stay throughout the delivery, so they act more as birth companions,” Dr Muriuki says. “We’re trying to transform their role and take advantage of their status to encourage women to deliver at the health facility.”
Maternity care has been free in Kenya since 2013, but the cost of getting to a clinic can still be prohibitive. The programme has been setting up community-owned referral systems that identify reliable transport providers – for instance, motorbike taxis – and offers a prepay system that means that the cost is covered before the service is needed.
Dr Muriuki admits that she was sceptical at first about a corporate-charity partnership, but says working on the programme has changed her way of thinking. One benefit she’s noticed is the intellectual exchange, particularly that offered by GSK’s PULSE scheme, which sees employees using their skills on full-time placements with non-profit organisations lasting three to six months.
One of those who has spent time in Bungoma County on the scheme is Mizunal Islam, a site procurement lead for GSK in Bangladesh. Getting to the heart of the county’s supply chain problems was critical in making sure that the right medicines were available at health centres, Islam explains. In doing so, the programme has been inspiring greater confidence among community members, who may have been put off in the past by walking long distances to clinics only to find that the drugs they needed weren’t available.
“When I met Ministry of Health officials at the beginning of my assignment, most people thought that the problem lay with the budget crisis, which was beyond their control,” Islam says. “But when I diagnosed the entire system, we looked at the root causes.” The investigation revealed issues such as a lack of standard operating procedures and the need for medical staff and managers to be trained in how to place orders, keep inventories and co-ordinate stock levels between all the facilities.
“These are small, small changes,” Islam says. “This kind of partnership is unlocking a huge opportunity.” Involving key stakeholders, such as health ministry officials, in the setting up of the improved system was key, so the programme will continue to run smoothly without outside help.
Later this year the programme will be expanded into Busia and Wajir counties. It has already trained more than 100 health workers to deliver babies in dispensaries and health centres and has distributed basic equipment to 30 health facilities. Knowledge-exchange groups are being set up to make sure that the model can be replicated elsewhere.
“One of the key elements is scalability, not just in terms of reaching the masses but being able to share what works for us,” Dr Muriuki says. “It’s not just selling a product at the end, saying ‘this and this works’. We’re selling the process.
“This is not just a traditional donor-charity relationship. It gives us flexibility as we go along. The minute we see something is not working we can tweak it. It’s not just ‘here’s the money, do something, give us results at the end of the programme’. The freedom it gives us to learn is a pretty different way of doing business.”
This feature first appeared on The Guardian - www.guardian/gsk-change - as part of a series exploring global health challenges.
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