“Women are not dying because of untreatable diseases. They are dying because societies have yet to make the decision that their lives are worth saving: We have not yet valued women’s lives and health highly enough.”
This is a quote by Professor Mahmoud Fathalla, a past president of the International Federation of Obstetricians and Gynaecologists. Eighteen years after he made this statement, maternal mortality remains a major challenge across the globe. Africa is disproportionately affected representing 70 percent of global maternal deaths. By the time you finish reading this article, two women will have died during pregnancy or childbirth. To significantly reduce maternal mortality rates worldwide, it is crucial to ensure that all women have access to safe, timely, and affordable surgical care, supported by investments in healthcare infrastructure, training, and community education
With just six short years before 2030, progress towards Sustainable Development Goal 3.1 has stagnated, and in some countries setback by the COVID-19 pandemic. In addition to challenges in accessing healthcare, the provision of delayed sub-optimal care has also led to maternal and neonatal deaths. Data by the UN Population Fund indicates that over 80 percent of maternal deaths in Kenya are attributed to poor quality of care. Kenya’s Maternal Mortality Ratio (MMR) remains high, with 362 deaths occurring per 100,000 live births. This data is a clear indication that despite the progress made in promoting access to maternal and child healthcare, the quality of care provided remains inadequate to generate significant progress in patient outcomes.
As we discuss issues of universal healthcare coverage, we should ensure that all mothers and children can access the same quality of care regardless of their location in the country. We need to expand availability but ensure the services provided are affordable and sustainable. We need to ensure that the service delivery quality gap that exists between rural and urban areas is closed.
Kenya, like many African nations, faces a profound challenge in ensuring equitable access to maternal and child healthcare. Even though there have been significant advancements in the construction of healthcare facilities, there is still a severe shortage of qualified medical personnel, especially in rural and underserved communities. This disparity not only affects the quality of care but also has dire consequences for the health outcomes of mothers and children.
The importance of having skilled healthcare workers cannot be overstated. For many expectant mothers in Kenya, the journey to a healthcare facility is just the beginning of their ordeal. Upon arrival, the absence of trained professionals such as nurse anesthetists can mean the difference between life and death. Nurse anesthetists play a crucial role in providing safe and effective pain management during childbirth, performing essential procedures, and ensuring that both mother and child receive the best possible care. Part of the challenge in Kenya is a significant shortage in the anesthesia workforce.
A 2017 survey by the World Federation of Societies of Anesthesiologists (WFSA) found that Kenya had just 0.44 physician anesthesiologists for every 100,000 people. When non-physician anesthesia providers (NPAPs) are included, this number increases to only 1.7 per 100,000. This is still well below the recommended 4 per 100,000.
Where they are available, there is an uneven distribution of skilled healthcare workers, skewed towards urban areas. This leaves rural populations, who make up the majority of the country’s demographic, with limited access to essential healthcare services. The challenge is not merely the presence of healthcare facilities, but the availability of trained personnel who can deliver quality care.
Investing in the training and retention of skilled healthcare workers is paramount. The government, in partnership with educational institutions and international bodies, must prioritize the development of comprehensive training programs for nurse anesthetists and other essential healthcare workers. Scholarships and incentives should be provided to encourage students from rural areas to enter the medical field, ensuring that they return to serve their communities.
To make sustainable impact, collaborative effort is required in both the private and public sector. No one stakeholder can do it alone. In Kenya, the Kenya Registered Nurse Anesthetists (KRNA) training was started at AIC Kijabe Hospital to mitigate the significant anesthesia workforce gaps in mission hospitals. With support from various partners, including the General Electric Foundation, Clinton Global Initiative, and Elma Philanthropies, this training was expanded to the public sector establishing KRNA training at the Kenya Medical Training College. A direct result is the significant increase in the number of trained nurse anesthetists from 57 in 2014 to over 520 today.
In addition, Kenya has hosted the inaugural Pan African Nurse Anesthetist Conference (PANAC 2024). The conference provides a platform for African nurse anesthetists to share experiences, learn, and disseminate best practices. The conference addressesthe severe shortage of anesthesiologists, particularly in Africa, where over 15,000 nurse anesthetists operate without a regional forum for professional development. This initiative hopes to establish a collaboration to improve the quality of training of nurse anesthetists in Africa in adherence to international accreditation standards set by the International Federation of Nurse Anesthetists (IFNA).
As the conference contributes to strengthening the maternal and child healthcare sector, the call to action is clear: the government, private sector, and civil society must come together to create a robust framework that supports the training, deployment, and retention of skilled healthcare professionals. This collaborative effort is essential to bridge the gap in maternal and child healthcare, ensuring that every mother and child, regardless of their geographical location, have access to the care they deserve. All these efforts need adequate funding, hence why the government must invest in human resources for health and policies that promote their recruitment, retention, fair remuneration, and equitable distribution.
By Mary Mungai, Patron, Association of Registered Nurse Anaesthetists-Kenya (ARNA-Kenya) and Gatwiri Murithi