Angela Mariuki

Guardian article: Why I put my signature on improving care for Kenya's mothers and newborns

Angela Muriuki finds that combating the high death rates in mothers and newborns in parts of Kenya involves knowledge of the culture of the people involved and the practical problems they face accessing healthcare.

Kenya is doing well at reducing the number of child deaths from diseases like malaria. Since 1990, deaths among children under five have fallen by almost a quarter.

But when it comes to the health of newborns or reducing maternal mortality, progress is not so good. Some parts of the country that you wouldn’t expect to be doing poorly are – for example, Bungoma County, in western Kenya. This is an agriculturally rich but densely populated area with abnormally high numbers of deaths of mothers and newborns relative to the total population.

Angela Mariuki illustration, save the children

As a senior programme manager with Save the Children in Bungoma, my team and I are trying to understand why this is the case, and hopefully come up with ways to give new mothers and their babies a better start. Our programme aims to help reduce maternal and neonatal mortality. What kills mums also kills babies. If there are delays in mothers getting the treatment they need, this will put the babies at risk too.

We undertook field trips to the Bungoma area to understand why death rates are so high among mums and new babies. We discovered that a combination of social, cultural and practical issues was contributing to difficulties in accessing healthcare.

A typical scenario could be: a pregnant woman is bleeding – the number one cause of death – but she either doesn’t know this is dangerous or can’t take the decision to get medical care herself. Or she knows she needs to go to hospital, and her husband is supportive, but there is a delay in getting to the facility. It may be too far away or it may cost too much. Then at the facility level: is it open? Are there trained healthcare workers? Do they have equipment? The Signature Health Programme aims to tackle these challenges.

My interest in public health grew from when I was a practising clinician at the coast in Kenya. I kept seeing the same cases: children would come into the clinic with diarrhoea, get treated, go away and then come back in with diarrhoea again. I thought there had to be another way to fix this. I was also working in a location where pregnant women had to consult their husbands before seeking medical care. It’s not as simple as: “I’m sick. I must see a doctor.” So I decided to go back to school to study the elements that influence choices in medical care.

Before starting post-graduate study in Edinburgh and Amsterdam, I worked in Liberia and the Democratic Republic of Congo. My decision to work in post-conflict countries arose as a result of the post-election violence seen in Kenya in 2007-2008. I also worked in South Sudan and Chad. Part of my postgrad was in policy and practice in conflict and Liberia was my first posting – it was probably the most memorable year of my life. What struck me was the joie de vivre of a people coming out of years of war and a country trying to find dignity in abject poverty. My memory of the DRC, where I oversaw a gender-based violence clinic, is the beauty of eastern Congo conflicting with the brutality of war. I asked a woman I met what would happen if there was a rumour of war. She said she had become good at packing up her family so she could move and survive in a new area; jerry cans for collecting water, seeds for planting, a family goat, and materials for shelter. I remember thinking that I can barely pack a suitcase at short notice! I’m not sure I have ever really recovered from working in DRC.

Almost two years ago, I moved back to Nairobi to work for Save the Children. Since I joined, my role has evolved from designing the health programme to putting it into action. We brought together people from the Ministry of Health, UNFPA, Unicef, the World Health Organization and several international non-governmental organisations. We looked at all the available health data before deciding which health issue should be addressed and why, and in which geographical area.

This led to us focusing on maternal and neonatal health – with support from GSK, the healthcare company with which Save the Children has a five-year partnership aiming to help save the lives of one million children. Normally when designing a programme, the donor’s criteria are already fixed and you respond. As a partner, GSK put in seed funding, which allowed us a lot of flexibility. We were starting from scratch based on need. Instead of curtailing us, it helped make sure we were progressing the way we intended, which we really appreciated. It is so rare to get that level of creative freedom from a donor.

We launched the programme, which is working through Kenya’s Ministry of Health to improve access to healthcare for pregnant women, in July last year. It is being implemented in a few counties across the country. What’s unique about this programme is that we can adapt as we go, learn in stages what works, and change as a result of that.

Now, I have a full team on the ground. A lot of our work is making sure we keep questioning what we’re doing, making sure the programme is implemented according to plan and according to budget, and that we bring in as many partners as possible. One of the things we need to do is to generate evidence, and make sure we are using the best approach to do this.

There is no such thing as a typical working day for me. The only thing that is consistent is that I wake up in the morning and go to sleep in the evening – it depends on what I’m working on that day. I could be working with the national health ministry in policy-development work, with the programme team providing technical support, or looking at operational aspects of the programme.

We are not just implementing a successful programme, but want to learn – to keep trying to find new ways of doing things.

I strongly believe that there are African solutions to Africa’s problems. If we pick multiple brains, we will come up with answers and Kenya is a perfect hub for that.

Dr Angela Muriuki is senior programme manager, Signature Health Programme, Save the Children and was interviewed for this article.

This feature first appeared on The Guardian as part of a series exploring global health challenges.