Nairobi — Up until 2019, nurses in three health facilities located in the semi-arid south-eastern Kenya region of Makueni County struggled to bring critical health services closer to a hard-to-reach population scattered across three remote, far-flung villages.
“Kamboo, Yindalani and Yiuma Mavui villages are located 17 and 28 kilometres away from Makindu sub-county hospital, and 10 and 22 kilometres away from the nearest electricity grid,” Benson Musyoka, the nurse in charge of Ndalani dispensary in Yindalani village tells IPS.
Without a cold chain capacity to store vital vaccines and drugs, health facilities records show vaccination coverage across these villages was well below 25 percent.
Babies were delivered at home because mothers could not raise 6 to 12 USDs to hire a boda boda or motorbike taxi, which is the only means of transportation in the area. Others could not reach the hospital in time to deliver.
“Every morning, I would collect vaccines at Makindu sub-county hospital and transport them inside a vaccine carrier box to Ndalani dispensary. Once the vaccines are inside the carrier box, they are only viable for up to six hours, at which point whatever doses will have remained unused must be returned to storage at Makindu sub-county hospital for refrigeration or thrown away,” Musyoka expounds.
In February 2019, a groundbreaking donation of a solar-powered freezer to the Kamboo health centre significantly improved availability and access to vaccinations as well as maternal health services across the three villages and surrounding areas.
Francis Muli, the nurse in charge of Kamboo health centre, tells IPS that without a fridge or freezer, “you cannot stock Oxytocin, and without Oxytocin, you cannot provide labour and delivery services.”
He says it would be extremely dangerous to do so because Oxytocin is injected into all mothers immediately after delivery to prevent postpartum haemorrhage. Oxytocin is also used to induce labour.
As recommended by the World Health Organization, Oxytocin is the gold standard for preventing postpartum haemorrhage and is central to Kenya’s ambitious goal to achieve zero preventable maternal deaths.
In 2017, the Ministry of Health identified sub-standard care in 9 out of 10 maternal deaths owing to postpartum haemorrhage. Overall, postpartum haemorrhage accounts for 25 percent of maternal deaths in this East African nation.
Usungu dispensary and Ndalani dispensary are each located 10 kilometres away from Kamboo health centre in different directions. Nurses in charge of the facilities no longer make the long journey of 28 kilometres to and another 28 kilometres from Makindu to collect and return unused vaccine doses on vaccination days.
“We collect vaccine doses from Makindu sub-county hospital at the beginning of the month and store them in the freezer at Kamboo health centre. The freezer is large enough to store thousands of various vaccine doses collected from the sub-county hospital for all three facilities,” says Antony Matali, the nurse in charge of Usungu dispensary in Yiuma Mavui village.
Two to three times a week, Matali and Musyoka collect doses of various vaccines, including all standard routine immunization vaccines, with the exception of Yellow Fever. The vaccines are transported to their respective dispensaries in a carrier box that can hold up to 500 doses of different vaccines, including the COVID-19 vaccines. All three facilities have recorded significant improvement in immunization coverage from a low of 25 percent.
At Kamboo health centre, where the freezer is domiciled, records show measles immunization rate has surpassed the target of 100 percent to include additional clients outside the catchment population area of 4,560 people. Overall immunization coverage is at 95 percent, well above the government target of 90 percent.
At Ndalani dispensary, the immunization rate for measles has also surpassed the target of 100 percent as additional patients, or transit patients from four surrounding villages and neighbouring Kitui County, receive services at the dispensary. The overall vaccination rate for all standard vaccines is 50 to 65 percent.
In the Usungu dispensary, the vaccination rate for measles is at 75 percent, and for other vaccines, coverage is hovering at the 50 percent mark.
“Usungu and Ndalani have not reached the 90 percent mark because we suffer from both missed opportunities and dropouts. Missed opportunities are patients who drop by a facility seeking a service and find that it is not available at that very moment. Dropouts are those who feel inconvenienced if they do not find what they need in their subsequent visits, so they drop out along the way,” Musyoka explains.
A cold chain or storage facility such as the solar-powered freezer, Muli says, is the cornerstone of any primary health unit in cash-strapped rural settings, and all services related to mother and child are the pillars of any health facility. Without these services, he emphasizes, all you have is brick and mortar.
“At Usungu and Ndalani, we are currently not offering labour and delivery services because we do not have Oxytocin in the facility at all times due to lack of storage, and we cannot carry it around in the hope that a delivery will materialize that day due to the six-hour time limit,” Musyoka expounds.
Still, pregnant women receive the standard tetanus jabs and all other prenatal services, but close to the delivery period, Ndalani and Usungu refer the women to the Kamboo health centre and follow-up to ensure that they receive referred services. Facility records show zero infant and maternal mortality.
Annually, the Ministry of Health targets to vaccinate at least 1.5 million children against vaccine-preventable diseases such as measles, polio, tuberculosis, diarrhoea and pneumonia. Currently, one in six children under one year does not complete their scheduled vaccines.
Only one in two children below two years have received the second jab of Measles-Rubella, and only one in three girls aged 10 have received two doses of the HPV vaccine which protects against cervical cancer.
Ongoing efforts are helping address these gaps. For instance, the HPV vaccine was introduced in Makueni in March 2021. Musyoka vaccinated 46 girls aged 10 years with the two doses of HPV vaccine in 2021, and another 17 girls received their first HPV dose in 2022 and are due for the second dose in November 2022.
Healthcare providers say the freezer has transformed the delivery of mother and child services in the area by bringing critical immunization services closer to a marginalized and highly vulnerable community.
IPS UN Bureau Report