Addressing the barriers that impede timely achievement of MDG5 targets is urgently needed in Kenya

In order to accelerate progress towards the timely achievement of MDG5 governments must take urgent action to address key obstacles to the attainment of improved maternal health, especially among populations with the most unmet need.

Women have constitutional right to life and health, and therefore their right to quality reproductive health services, which ensure that every pregnancy is wanted; all pregnant women and their infants have access to skilled care; and that every woman is able to reach a functioning health facility to obtain appropriate care in the event of complications. Up to 75 percent of all maternal deaths can be averted if women received timely and appropriate medical care. We know the causes of these deaths and how they can be prevented.

Kenya has already put considerable effort to policy development and strategic planning with the aim of accelerating the attainment of health related MDGs, however, these are yet to translate to actual reduction in maternal deaths. Despite the recent observation of an upward trend in contraceptive prevalence rate (CPR), which raises hope that if it can be sustained, there may be possibility of attaining Target 5B of MDG5 by 2015, the country has neither registered any downward trend in maternal mortality ratio (MMR), neither is there any convincing evidence of an increase in the proportion of births attended by skilled health personnel (Target 5A).

However, successive surveys and other evidence show several serious obstacles remain which interfere with effectiveness of reproductive health interventions, and which must be addressed as a matter of urgency. These include the serious disparities which persist in reproductive health outcomes, especially in relation to area of residence and socio-economic status. Reproductive health indicators deteriorate as the socio-economic status declines and vice versa; so is the case as the distance from the main urban centres increases. Generally, the poor lack access to health care in terms of availability and affordability.

A key barrier is the weakness in health system[i]: health infrastructure, trained human resources, and efficient operating systems. Provision of reproductive health services cannot be considered in isolation, and generally, these services are strong where the health sector is strong, and vice versa. The leading cause of the weak health system is inadequate funding of the health sector. Effective service provision requires an adequate infrastructure, and human and material resources, and ultimately, adequate financial allocation. This is why it is disconcerting that Kenya Government’s allocation to the health sector continues to lag way below what was promised at Abuja in 2001 and in Kampala in 2010. For the fiscal year 2010-11 Kenya allocated just about 5.5 percent of the total Government expenditure to the ministries of Medical Services and Public Health and Sanitation, a level of investment that does not demonstrate high prioritization of maternal death prevention and reduction among the national priorities.

The MDGs are inter-related, so that achievement of MDG5 is closely tied to the progress made in several other goals, especially eradication of extreme poverty and hunger (Goal 1), universal primary education (Goal 2), promotion of gender equality and women empowerment (Goal 3), and combating HIV/AIDS, malaria and other diseases (Goal 6). Clearly, if the MDGs are to be achieved by 2015, not only must the level of financial investment be increased, there is need for a rapid scale up of more innovative programmes and policies which aim at overall development and economic and social transformation, nationwide.

It is thus imperative to implement a deliberate effort to target populations with the most need; these in most cases include urban and rural poor, the “hard to reach” groups and people with disabilities. In Kenya, most reproductive health indicators clearly portray big disparities between the poor and the ‘hard to reach’ on the one hand, and on the other, the urban better offs. Health planners must ensure that health needs peculiar to the ‘marginalised’ are factored in, and adequately addressed, in the planning of health services.

Finally, the Constitution of Kenya (2010) provides opportunities for enhancing health in general, including reproductive health and rights of Kenyan women. Article 43 (1)(a) states: Every person has the right to the highest attainable standard of health, which includes the right to health care services, including reproductive health care. In addition, Article 27 guarantees the right to equality and freedom from discrimination, which encompasses within itself the right of the poor and marginalised persons to adequate and quality health care.

[i] According to the World Health Organisation a health system comprises all structures, institutions and resources that are devoted to producing actions whose primary intent is to improve health.

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