Decentralising maternal healthcare in Kenya: who’s happy and who’s not

Published on 3 April 2017

In this blog, the third in a series on Interrogating Decentralisation in Africa, researchers from Kenya dramatize – through Kenyan storytelling – their recent study on citizens’ perceptions of the impact of decentralisation on healthcare in Kenya. The characters in the story are ficticious.

Availability of ambulances at sub-County level has not only translated into availability of referral maternal are but also of reachability of referral facilities and services.

Photo: Availability of ambulances at sub-County level has not only translated into availability of referral maternal are but also of reachability of referral facilities and services.

A young hospital chaplain enters the mothers’ hostel at a referral hospital in western Kenya. Lying with her head resting on the foot of her hospital bed, Janet Mwananchi looks like she can easily fall off the bed. She is sharing the bed with another woman. They are lying back to back. The bed mate is wearing an enigmatic smile. She is looking adoringly at the neat bundle of white and pink that she is holding. It is a baby! A tiny non-descript pink face with the rest of the body swaddled. The infant is suckling, eyes half-closed as if she is tired of struggling to stay awake.

The chaplain walks to the foot of the bed where Janet’s head is propped. Janet’s is also suckling her slightly older-looking baby who is wearing a warm-looking oversized overalls. She holds the baby gingerly as if she is afraid that he would disintegrate and fall through her fingers. Slowly, carefully, she pulls out the baby’s right fist from under the oversized sleeve. The chaplain eyes meet hers. They smile at each other, slightly embarrassed. His eyes do a swift sweep of the room. Numerous pairs of eyes meet his, searching into his face for a clue to his inexplicable friendliness.

“Habari zanu? (How are you all?)” he ventures with a continued smile.

Mzuri sana (Very well)” the ward choruses back, almost in rehearsed unison.

He introduces himself as the new hospital chaplain and shyly explains his brief spiritual mission. He turns back to Janet. Her smile broadens to reveal a set of perfectly set brilliant white teeth. He is suddenly reminded of his dreaded appointment with the dentist, long overdue thanks to the on-going doctors’ strike.

“How long have you been here?,” he asks.

The question opens a floodgate. Janet goes into great detail about how she came to the hospital more than two months before, gave birth to a baby boy who developed breathing complications that forced their long stay in the hospital. Although she speaks in a low tone, barely above a whisper, the pin-drop silence that envelops the room ensures that her story reaches every corner.

“I’m so grateful to everybody – the doctors, the nurses, everybody. They have been very kind to me. Devolution has done wonders. The last time I was here in 2010, things were not very good. I came in, gave birth and went home the same day. But I was charged a lot of money. This time round, I have stayed for over two months, with good treatment every day and I get everything that I need. They give me food, medicine, and even diapers for my baby. All for free!” Janet effuses.

Janet’s bed mate chimes in with her own gratitude. She relates how it was easy for her to be rushed to hospital when she developed complications at home because all they did was call a boda boda (public motorcycle) on her husband’s mobile phone. Under ten minutes, the boda boda came. She attributes this to good feeder roads built by the county government.

After what seems like eternity, the chaplain conducts a short prayer session. As he walks out, the paediatrician doing the ward rounds follows him to the door, greets him and without waiting for response launches into a tirade.

“I like your job. The mothers are very relaxed talking to you. But do you know how difficult it is for me? When I look at Janet, for example, I don’t know how to tell her that her child has a condition that requires a surgical procedure, though a fairly simple one. But you know what, that baby will die if the surgery is not done soon. I keep hoping the national government send more supplies so that we can operate on the baby. This hospital is so overcrowded! Lower level hospitals are even worse. The county government has received money to equip the district hospital, but where have they used the money I don’t know… In this referral hospital, we have to deal with non-referral cases which should be handled at lower levels. Nobody cares! We went on strike the other day. Nobody listened to us for three months. Only on the 100th day some of our grievances were addressed. They need to get their act together…” She stops abruptly.

The chaplain blinks in confusion, searching his mind to say something clever and comforting, but drawing a blank. He smiles coyly and walks off in bewildered defeat.

Eunice Kamaara is Professor of Religion at Moi University. Susan Kilonzo is a Senior Lecturer in the School of Arts and Social Sciences at Maseno University. Kitche Magak is Associate Professor of literature and Head of Department of Literary Studies at Maseno University. All three are instructors on the annual Advanced Training for Multi-Methods and Policy-Oriented Research, offered by the Partnership for African Social and Governance Research (PASGR).

The views expressed in this opinion piece are those of the author/s and do not necessarily reflect the views or policies of IDS.


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