Maternal health at stake as attention shifts to Covid-19

Lilian Kaivilu @liliankaivilu

Francis Lenkupae is the nurse in charge at Lerata Dispensary in Samburu East, Samburu county.

This April, Lenkupae marks two years since he last took leave. “I am the only health worker here;  my schedule cannot allow me to take leave,” he says.

He works with a team of support staff, including a night guard, a nurse and a cleaner.

Behind Lenkupae’s office is a grass-thatched maternal shelter. Three women sit inside the structure that has two beds and a fireplace.

One of them, Ayaya Lesaiyari, carries a nine-month infant while the other is six months pregnant.

“This is a better option as it looks like our ordinary houses. I was brought here by my family one week before delivery,” says Lesaiyari. 

The facility is meant to enable women from the pastoralist communities have a homely feel while giving birth in a health facility. Ordinarily, women come here a few days before their due date.

This, Lenkupae says, reduces cases of maternal and new born deaths that may otherwise occur during home deliveries.

“With no or limited means of transport also, this facility serves as a waiting area for the women who come from far away. The fireplace in here keeps the place warm at night,” he explains. 

According to United Nations Population Fund Kenya (UNFPA) representative Dr Olajide Ademola, transportation remains a critical barrier that reduces the impact of interventions including the free maternity policy which doesn’t cover transportation between a woman’s home and the health facility.

“It is critical that all women have access to safe birth, the continuum of antenatal and postnatal care, including screening tests according to national guidelines and standards, especially in epicenters of the pandemic, where access to services for pregnant women, women in labour and delivery, and lactating women is negatively impacted,” said Ademola. 

As the country battles the deadly corona virus medical practitioners have to observe extra hygiene measures both within their health facilities as well as during medical operations.

But Lenkupae, who performed a delivery on April 1, 2020, says his facility is yet to receive essential protective gear.

“I performed one delivery on April 1. Although we received training from the Samburu county referral hospital on how to protect ourselves, we do not have the personal protective masks yet,” says Lenkupae. 

According to him, locals perceive the disease as a preserve for those living in urban cities.

As a way to curb the spread of the virus, the dispensary has installed a hand washing station and frequently reminds patients to keep distance from one another as they await treatment. 

With a population of 58,122, Samburu East Constituency is served by 28 health facilities, according to the Ministry of Health.

This means one health facility serves at least 2,000 people in the constituency. Lesaiyari and her colleague Boina Ketaare are lucky to reach this facility. 

“Many women come from far. They sometimes have to make tough decisions between giving birth at home and walking miles to the nearest health facility,” says Lenkupae.

Coronavirus effects

And with the ongoing curfew by the government in a bid to curb the spread of Covid-19, access to maternal health become tougher.

This, experts say, will adversely affect the neonatal and maternal health indicators in the country.

Dr Mohammed Kuti, Isiolo governor and the chair of Health committee in the Council of Governors says many mothers might not come to the hospital for fear of contracting the deadly disease.

“The fear for Covid-19 is likely to instil fear among people hence reduce instances of visiting a health facility as hospitals are viewed as possible contamination points for the disease. This will, in turn, disrupt the maternal health indicators across the country,” said Kuti. 

Gladys Ng’eno, Project Lead Maternal and Newborn Improvement-Quality of Care (MANI-QC) at Options, says if not well contained, Covid-19 is likely to reverse the gains made in maternal and new born health.

With hospitals being closed in preparation to serve as isolation centres, Ng’eno says this should be done with caution so as to ensure other essential health services run smoothly.

“Counties should consider converting a 24-hour dedicated facility with all the required facilities and human resource. This will shield many mothers seeking maternity services,” she said. 

Ng’eno added: “Let us not forget that there are children to be immunised, malaria and TB patients who need to continue their treatment.”

She opines that counties ought to review all cadres of health workers and prioritise essential health services. “Otherwise, we will have more cases of maternal deaths while preventing Covid-19.”

In Mombasa county, maternity services, alongside others, have been suspended at Tudor Hospital since Thursday, March 26, 2020. According to Dr Shem Patta, the county director if health, the Level Four health facility was closed in preparation for isolation services.

“This facility was already offering antenatal as well as delivery services. It was a high-volume delivery hospital. This means the maternal healthcare services will be affected,” said Dr Patta. 

Out of the 1,700 health workers in the county, the government has already started preparing some of the staff for Covid-19 response.

Dr Patta says all the medical staff previously working at the Tudor Level 4 hospital will be handling Covid-19 cases. At the Coast General Hospital, one of the wards was turned into an isolation ward.

“Covid-19 is already having an effect on maternal health. This is because we have to mobilise all cadres of staff to undertake the response to the disease,” added the DMS. 

With already a strained workforce of 1700 healthcare workers the county, just like others in the country, will have to reorganise its health workers to handle the delicate balance between Covid-19 response and other essential services. 

“Some facilities will most likely be converted to isolation centres. Many of these were previously serving maternity and other patients.

“There is already confusion on where patients would go for their ante-natal clinics there are being turned away. Unfortunately, they were scheduled to have their deliveries there,” said Dr Patta. 

The county has also restricted hospital visits for pregnant mothers and other patients.