Picture this: A woman, in labor. She’s at home, it’s the middle of the night, and she is afraid to head to her local health facility for fear she will be arrested…
Many women in Kenya faced this very challenge at the onset of the COVID-19 pandemic, and during the resultant 7 p.m.– 4 a.m. curfew. Rampant misinformation, fear, and a lack of guidance meant that many women were giving home births and not getting the critical sexual and reproductive health care they needed.
“We lost mothers because of the delay in access to health services,” said Eileen Mokaya, Country Director of Pathfinder in Kenya. “They were fearful because of the curfew. If you were caught, you were put in the police station. In the first month (of COVID-19), we had a number of maternal deaths. And they could have been avoided.”
Knowing that the curfews were prohibitive—that women needed continued access to maternal and neonatal health care from skilled health providers in safe health centers—our Afya Pwani program mobilized rapidly.
The first step? Recruiting, mapping, and certifying local boda boda drivers— think a motorbike Uber for pregnant women.
“We worked with local administration and county department health officials to identify boda bodas,” said Mokaya. “They get a letter to say they can carry pregnant women to the facilities. We got people the police knew, who have good records, and they were given the leeway to carry the women. We then saw the progress—women came back to the health facilities.”
Next, Afya Pwani made the local referral system to health centers more robust. While there was a local calling center in place, the staff didn’t always know how to manage referrals, as certain health centers were designated for triage and others for services like maternal health and birthing due to COVID-19. Pathfinder worked to put qualified clinicians into the call center.
“We realized, when someone random picks up the phone they might mis-prioritize the need. But if you have a midwife, she can say where the woman needs to go and who is there to help attend to her needs. This saved lives,” said Mokaya.
And the most important part of Afya Pwani’s strategy, the one that runs through each adaptation? Listening. “Communities have the answers,” said Mokaya. “Our philosophy is community first. Listen to them and they will figure out how to solve the problems.”