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Kenya, 4 January 2018: Life-saving cash transfer programme enshrined in Kakamega law

© UNICEF Kenya/2017/Oloo
A mother and her daughter during the launch of the Kakamega County Maternal, Child Health and Family Planning Act, 2017.

By Anna Jardfelt, Swedish Ambassador to Kenya and Werner Schultink, UNICEF Representative in Kenya

Picture a faraway, hard-to-reach village, deep in rural Kenya where most families, if they are lucky, live on less than 100 shillings a day. Now picture a young woman in the same village, in her final trimester of pregnancy, battling between making a decision to go and work on her tiny shamba in order to support her family, or walk for 10 kilometres to a health centre for a check-up on what could be a pregnancy complication with severe consequences.

More often than not, the decision to stay at home or to go out looking for a livelihood trumps that of seeking expert medical attention. This is true for many mothers who come from severely disadvantaged backgrounds. They simply do not have the means or are burdened with more pressing household needs.

In the same breadth, thousands of children miss out on important basic health services early in their lives such as immunization with many succumbing to completely preventable diseases. But there seems to be a way around reversing this worrying state of affairs.

A case in point is Kakamega County which in 2014 was ranked fifth amongst 15 counties with the worst reproductive maternal neonatal child and adolescent health statistics in Kenya. The maternal mortality rate was at 316 deaths per 100,000 live-births while newborn deaths were at 19 for every 1,000 births.

According to the Kenya Demographic and Health Survey of 2014, at least 64 children under 5 years were dying out of every 1000 born. This was largely attributed to the poverty rate of 49.6 per cent with more than 33,000 mothers living on less than a dollar a day. There was also very low knowledge on the best practices around ante-natal care, skilled delivery and post-natal care.

Currently, the situation in Kakamega has made a major turnaround. The proportion of skilled delivery has increased from 33 per cent in 2013 to 69 per cent by 2016, while the proportion of mothers who have attended their fourth Ante Natal Care visit has gone up to 54 per cent, up from 35. Similarly, immunization coverage of children is now at 81 per cent compared to 63 back in 2014.

So how did Kakamega manage this turnaround in their maternal and child health indicators? The Imarisha Afya ya Mama na Mtoto (Improve the Health of Mother and Child) Programme contributed significantly to this improvement. The programme was initiated by the County Government of Kakamega, and was designed to reach the neediest in the county - a literal life-saver for over 44,500 mothers who have benefitted from it.

Commonly referred to as Imarisha Afya, the programme targets poor and disadvantaged pregnant and breastfeeding women, encouraging them to use maternal and child health services by assisting them with regular cash transfers.

The project delivers six cash payments of 2000 shillings over a period of 18 months. These small amounts enable these poor pregnant women and mothers to cover transportation costs to health facilities and to even buy food and other necessities for their children.

© UNICEF Kenya/2017/Oloo
Kakamega County Governor, Wycliffe Oparanya (second left), Swedish Ambassador to Kenya, Anna Jardfelt (center) and UNICEF Kenya Representative, Werner Schultink (right), during the launch of the Maternal, Child Health and Family Planning Act, 2017.

UNICEF and Sweden have supported the programme since its inception in 2014 by providing technical assistance and guidance. What started out as a basic idea to provide milk to children took on a much more comprehensive and sustainable approach of addressing access and uptake of health services.

We made the argument to the Governor and his government to consider social protection to improve maternal and child health in place of inappropriate feeding using milk, especially for newborns.

If you take care of a woman during pregnancy and continue to offer skilled care during birth and the first 1000 days of her baby’s life, then you can truly maximize on the window of opportunity, where health and nutrition interventions have the highest impact.

While recognizing the need to provide cash transfers to address financial barriers that limit access to health services, the Imarisha Afya Programme, also acknowledges the key role of complementary services.

UNICEF through the Maternal Neonatal Child Health (MNCH) Programme in Kakamega, supports additional activities such as awareness raising and counselling, as well as overall improvement of quality of health service, in order to enhance utilization of available services.

Imarisha Afya is today fully funded by the county government with a budget of USD 1 million. The county has recently gone a step further in making the project sustainable. On 16 November, the Governor launched the Maternal and Neonatal Child Health and Family Planning Act that establishes a fund to support the initiative.

The Act earmarks 3 per cent of the county’s annual health budget for Cash Transfers and at least 1.5 per cent to pay stipends for Community Health Volunteers. In the context of devolution, the passing of the Act represents a major event in county health management. It is an innovative law addressing reduction of child and maternal mortality.

Through this law, Kakamega County has gone beyond making a pledge to safeguard the health of women and children. They have guaranteed the availability and predictability of funds to sustain the programme for the long haul.

As the county enters a new era of improved maternal and child health, we would like to renew our commitment as UNICEF and Sweden, in working with the county government and all other partners to further strengthen the protection of the well-being of women and children in Kakamega and all other disadvantaged counties. We sincerely hope that more woman decides to seek maternal and child health services.



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