Background: Approximately 15% of expected births worldwide will result in life-threatening complications during pregnancy, delivery, or the postpartum period. Most maternal and neonatal deaths in low-income countries, including Kenya, are attributable to a handful of preventable causes. Emergency obstetric and newborn care (EmONC) is an integrated strategy that aims to equip health workers with skills, life-saving medicines, and equipment to manage the leading causes of maternal and newborn death. It is on this basis that this study was conducted to find out how the BEmONC training impacted on the reproductive health services that the people of West Pokot are receiving despite the several challenges the county is facing to include a high burden of maternal and newborn mortality.
Objectives: The broad objective of the study was to assess the effectiveness of Basic Emergency Obstetric and Neonatal Care (BEmONC) Training Program in West Pokot County, Kenya. The specific objective was to establish challenges and opportunities in service delivery of BEmONC services, following the training program that was rolled out in the year 2014, in West Pokot County, Kenya.
Methods: A methodological triangulation design was used as it incorporated elements of both quantitative and qualitative approaches. Informing this decision was the Pragmatic worldview. Quantitative approach adopted a descriptive cross sectional ex post facto design of 49 randomly selected health facilities. The BEmONC observation checklist, guided and in-depth interviews were used to collect qualitative data. The sample size was purposively determined when saturation of the data was reached and data was analyzed thematically.
Results: Findings indicated that the Basic Emergency Obstetrics and Neonatal training program was effective but the level of its effectiveness varied by facility type, designation, geographical setting and operating agency. The challenges that affected BEmONC service delivery included understaffing (92.6%), lack of supplies and equipment (63%), poor infrastructure (44.4%), ineffective transport and communication (69%), insecurity (42.9%) and insufficient water supply. A new collaborative health insurance program that provided health care coverage for Kenya's poorest was one common opportunity identified.
Conclusion: The AMPATH sponsored BEmONC training was effective as it led to improved care and better BEmONC outcomes, however, its effectiveness varied by facility type, designation, geographical location of facility and operating agency. Key items lacked in many facilities and relatively few had all the required commodities and equipment to provide BEmONC. Challenges that adversely affected the delivery of high-quality maternal and newborn care services were overwhelmingly higher than the opportunities.
Recommendations: This study recommends advocating for a complete BEmONC system by: Availing all the essential equipment, drugs and supplies; Improving strategies to sustain knowledge and competencies of the providers as well as maintain equipment and supplies for use to avoid wear and tear; Improving supply chain management for essential commodities at the peripheral facilities.
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