Adapting the 2015 Mother-Baby Friendly Birth Facility Guidelines for Semi-nomadic Pastoralist Communities in Laikipia and Samburu Counties of Kenya.

Purpose To adapt the 2015 International Federation of Gynecologists and Obstetricians (FIGO), International Confederation of Midwives (ICM), White Ribbon Alliance (WRA), International Pediatric Association (IPA), and WHO auspiced Guidelines on Mother-Baby Friendly Facilities to a particular sub-population; seminomadic pastoralist communities of Laikipia and Samburu Counties, Kenya. We anticipate an increased utilization of childbirth services by improving their acceptability. Description We drafted a Pastoralist Friendly Birthing Facility Checklist based on the FIGO/ICM/WRA/IPA/WHO guidelines and previous research in this context. We employed mixed methods to finalise the adaptation: a workshop with 27 local stakeholders; interviews with ten health planners and skilled birth attendants (SBAs); and ten focus group discussions (FGDs) with health committee members, community health workers, mothers and traditional birth attendants (TBAs). A facility audit of dispensaries across five group ranches was also undertaken. Assessment The final Checklist was divided into: characteristics of care and the environment; care during labour and birth; post-partum care; and community staff relationships. It was endorsed by the Ministries of Health in the relevant counties, and by women, SBAs and TBAs. No facility currently satisfies all the criteria specified in the Checklist. Conclusion The FIGO/ICM/WRA/IPA/WHO Guidelines were successfully adapted and can be used to ensure health facilities meet the needs of pastoralist women.

Walking Together: Towards a Collaborative Model for Maternal Health Care in Pastoralist Communities of Laikipia and Samburu, Kenya.

Purpose In 2009 the Kenyan Government introduced health system reforms to address persistently high maternal and newborn mortality including deployment of skilled birth attendants (SBAs) to health facilities in remote areas, and proscription of births attended by traditional birth attendants (TBAs). Despite these initiatives, uptake of SBA services remains low and inequitably distributed. This paper describes the development of an SBA/TBA collaborative model of maternal health care for pastoralist communities in Laikipia and Samburu. Description A range of approaches were used to generate a comprehensive understanding of the maternal and child health issues affecting these pastoralist communities including community and government consultations, creation of a booklet and film recognising the contributions of both TBAs and SBAs that formed the basis of subsequent discussions, and mixed methods research projects. Based on the knowledge and understanding collectively generated by these approaches we developed an evidence-based, locally acceptable and feasible model for SBA/TBA collaborative care of women during pregnancy and childbirth. Assessment The proposed collaborative care model includes: antenatal and post-natal care delivered by both SBAs and TBAs; TBAs as birth companions who support women and SBAs; training TBAs in recognition of birth complications, nutrition during pregnancy and following birth, referral processes, and family planning; training SBAs in respectful maternity care; and affordable, feasible redesign of health facility infrastructure and services so they better meet the identified needs of pastoralist women and their families. Conclusion The transition from births predominantly attended by TBAs to births attended by SBAs is likely to be a gradual one, and an interim SBA/TBA collaborative model of care has the potential to maximise the safety of pastoralist women and babies during the transition phase, and may even accelerate the transition itself.