To help pregnant women in Western Kenya get to health facilities before and during labour, we needed to develop a system where trust and safety take priority, and which encourages access to health facilities that offer improved services.
In Western Kenya the terrain is unforgiving. Mountainous, unlit and unpaved roads – many of which are impossible to travel by car – are hard to navigate even for motorbikes.
This means pregnant women are often forced to give birth at home where facilities are scarce and conditions are risky. Without a health carer present, both mother and baby are vulnerable to life-threatening complications.
Save the Children has helped facilitate the recruitment of a team of local ‘boda boda’ – or motorbike – drivers to bring pregnant women to health facilities.
The boda boda drivers were selected through community consultation. Drivers need to own their motorbike, to be available around the clock and to be insured. The community came together to select one driver in each village, so that the relationship with the drivers was built on a sense of community, ownership and trust. Their cargo is precious – so safety was the number one priority.
Birth prepping and planning
So while the process of selecting drivers was going on, our program team worked with the community and stakeholders to close the cycle and ensure quality, awareness and access.
Traditional birth attendants were retrained to act as birth companions who could go with the mother to the health facility when she was ready to deliver.
Community health workers raised awareness of the importance of antenatal visits and safe birth. Men’s local committees (barazas) were approached with messages of awareness of the importance of planning and health around pregnancy. And health facility staff trained mothers to recognise danger signs and showed them how to make a pregnancy and birth plan.
The nurse in charge at the Siboti Health Centre told us the results of this concerted effort have been striking.
“Before the boda boda drivers, we had 30 mothers delivering in the facility every month. Now we have 60 every month… everyone has the number of the boda boda driver, so they can call him and come to the facility,”
Women can use the boda boda service both for the first and final (fourth) antenatal visits, as well as when they go into labour. Having been given the boda boda driver’s number in their sessions with the community health worker, the woman can contact him directly or through her birth companion.
Around two thirds of women in labour attend the facility with a birth companion, who can also assist if there are complications on the sometimes long or difficult journey to the facility. When they arrive, the nurse in charge at the health facility or hospital registers the woman and approves the boda boda driver’s journey.
As the project winds down, communities are developing approaches to ensure they can maintain the service.
Save the Children currently reimburses the boda boda drivers for each trip made for an antenatal visit and for a birth. The communities are now discussing ways in which they can come together to pool resources – paying small monthly amounts into a community fund, which can then support the boda boda drivers by paying for their time and fuel.
It’s fantastic to see how the support of our donors has enabled such a life-saving project – which can now be sustained by the community themselves.
Pregnancy should not be life threatening. The responsibility to take action and improve access to basic services for pregnant women is a communal one. It needs women’s voices to be heard and communities’ resources to be invested in women’s and babies’ health.
Photos: Allan Gichigi- Save the Children