Before the devolved system of government, six regions contributed to the more than half of maternal mortality cases recorded in Kenya.
Marsabit, Migori, Mandera, Wajir, Isiolo, Kwale and Lamu had the highest cases of maternal deaths — making them the worst places for childbirth in the country.
The UNFPA ranked Mandera as having the highest maternal mortality ratio (MMR) — 3,795 per every 100,000 live birth while Isiolo’s estimate was 790 deaths per 100,000 live births.
And now, authorities in Isiolo and Mandera have proposed efforts to reverse the trend.
In Isiolo and Mandera, the high cases of maternal deaths have been linked to low education, low contraceptives use, cultures such as Female Genital Mutilation (FGM), child marriages and overall inadequacy of health facilities and skilled personnel.
According to health officials, Mandera now records 588 per 100,000 live births.
Both counties have focused on improving the number of health personnel as well as medical facilities and equipment.
For example, Mandera which had 34 operational health facilities in 2013 now has 84 while Isiolo’s 47 five years ago have grown to 57 facilities in a bid to make health services more accessible.
Mandera Health executive Mohamud Adan Mohamed says that given the vastness of the county, they have invested heavily in buying eight ambulances that get emergency maternal cases to the closest health facilities in Ramu, Takaba, Banisa, El-Wak and the Mandera Referral Hospital.
Lack of adequate staff remains one of the biggest challenges to the provision of sound healthcare in public hospitals and Mr Mohamed says that the county has hired and trained more personnel on basic emergency and obstetric care.
Obstetric care is critical to reducing maternal and neonatal mortality.
In Mandera County, about two in five (39 percent) births by a skilled birth attendant compared to 62 percent at the national level.
“We have made deliberate investments in increasing the number of health workers in the county. Pre- devolution we had one doctor in this entire county but now we have 110 nurses in the referral hospital as well as 32 medical facilities,” said Mr Mohamed.
Ante-natal care helps in identifying adverse pregnancy outcomes when it is sought early in the pregnancy and is continued until delivery.
The World Health Organisation recommends women should have at least four ante-natal care visits during each pregnancy. County data on antenatal care is not available.
In the upper Eastern region where these two counties are found, only 37 percent of women of reproductive age receive antenatal care at least four times during pregnancy, which is considerably lower than the national rate of 58 percent.
“Women come here at the late stages or when they get complications, which impede successes we have made in reducing the number of deaths in the county,” says Mr Mohamed.
Isiolo Governor Mohamed Kuti says local community health volunteers have been trained to identify pregnant women within clusters of around 10,000 people, and link them to the health facilities to receive ante-natal care.
“The volunteers provide health education to the pregnant mothers on the importance of ante-natal care services, the knowledge and importance on how to recognise danger signs during pregnancy, during delivery and post-delivery,” he says.
Already, deliveries under skilled care are going up, helped by Isiolo government’s free maternity care scheme.
In Mandera, women are trained to recognise warnings of possible or imminent danger to mother and child.
They are also given a stipend of Sh500 for every mother they bring to the facilities.
The new mothers are also given a care package which includes nets, soap, shawls, sanitary towels .
These act as incentives during delivery and many women have been receptive to the plan.