Mobility helps mothers to access hospitals with ease, boosting mother and child’s health. FILE PHOTO | NMG
As 2019 begins, it’s an opportunity to reflect on 2018. During
the Christmas holiday, the nativity scene of Mary and Joseph in a manger
reminded me of our maternal child health indicators. No official
records exist, but perhaps Mary too faced perhaps worse maternal and
neonatal mortality risks than exist now.
Historians
suggest that Joseph took Mary “home” to deliver close to his relatives
in Bethlehem, a not uncommon occurrence among urbanites in informal
settlements.
Traditionally, this is for the provision
of family support for mothers. Their trek of about 105km, was quite
arduous for a pregnant woman, even on a donkey.
Last
year, as part of a series of articles on mobility and health, I had the
privilege to traverse the city, logging a total of 1,786km assessing
challenges as well as the potential impact of road projects to
healthcare in Nairobi’s poorest neighbourhoods.
Most of
the roads were funded by the World Bank, African Development Bank and
Kenya Urban Roads Authority with a constellation of shorter cabro and
bitumen ones done by constituency development fund and MCAs’ ward
kitties.
Though not intended reasons for building
roads, an overshadowed impact of such projects is what accessibility
contributes to health outcomes.
This powerful yet
overlooked part ought to be part of their narrative. Not just the length
of roads built. The human element resonates better with people on the
ground. For pregnancy-related complications, ease of mobility is
particularly important, given the sometimes sudden and dramatic turn of
events from ordinary to potential catastrophe around childbirth.
Given
the time of labour, the majority of home deliveries are at night when
insecurity and a lack of roads restrict movements of patients.
Proximity is king and when a 45-minute walk at night is
translated to a 10-minute ride, the probability of delivery in a health
facility rises. Ease of mobility for medics and community health workers
also is important.
One series of five-year data
analysis indicated that an average of 37 per cent deliveries occurred
outside the hospital nationally.
In urban areas, while
55 per cent of deliveries are in public health facilities, 17 per cent
still occur at home. This segment could be a big chunk of informal
settlement dwellers.
In one of the facilities
evaluated, metrics like antenatal care attendance frequency, distance
radius to a facility delivery, all correlated with the lack of or
presence of good roads.
In the Ngomongo-Babadogo area, a
cul de sac and a small river that previously prevented mothers from
accessing services 500m away. An ongoing tarmac road is already showing
impact with mothers now moving easily. We have more to complain about,
but on this metric, the Nairobi governor, MCAs and MPs serving such
areas deserve a pat on the back. My best takes are Mathare-Huruma,
Congo-Kawangware, Kasarani-Githurai, Dandora-Kariobangi-Korogocho link
roads.
Happy New Year to this column’s readers!
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