Strategies for Building RH Champions: A case of Kenya Private Nurse Midwives Networks

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Strategies for Building RH Champions A case of
Kenya Private Nurse Midwives Networks

• Presented at the Mini University at George
  Washington University, Washington DC, October 27,
  2006
• by
• Pauline Muhuhu
• Best Practices Advisor
• Extending Services project

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Purpose of Presentation

• Share Kenyan experience with peer support
  Networks for service quality improvements for the
  underserved populations.
• Advocate for recognition and support for this
  group as Champions for RH.

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Introduction

• The private nurse midwives role in reproductive
  health at community level
• History of the Networks
• Networking
• Nakuru Case Best Practrice
• Challenges
• Conclusion

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Private Nurse Midwives

• Nurse midwives are registered by Nursing council
  of Kenya licensed to operate private clinics.
• Operate small clinics or maternity and nursing
  homes.
• Must Maintain the license to practice through
  annual set CEU

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Services Provided by Private Nurse Midwives

• In Clinics
• MCH/FP services
• Curative out patient services for minor ailments
• PAC services
• Community education
• PMTCT

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Services at A Maternity Home
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Services - 2

• Nursing Maternity Homes
• As in the clinics plus
• Deliveries
• Admissions for treatment of general ailments

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The Networks - 1

• Formalized in 2000 in response to the need for
  support supervision in delivery of Comprehensive
  PAC services.
• Current membership varies from cluster to cluster
  but there has been growth in membership in each
  cluster

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The Networks - 2

• Objectives of the Clusters
• To provide technical support to cluster members
  to augment MOH supervision role
• To Provide welfare support to its members to
  ensure quality and sustainability of services

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Networks - 3

• Networks Are Located in
• Rural areas
• Urban poor
• Peri-urban densely populated areas

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How Clusters Function

• Membership by application
• Must own a private clinic/maternity/nursing home
• Assessment of the facility by members for service
  quality
• Periodic peer reviews
• Continuing education for members

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How Clusters Operate -2

• Contributions to a cluster revolving fund
• Application of the funds to support needy cluster
  members for improvement of the facility.
• Sharing of contributions for facility
  improvements.
• Collaboration with local MOH agencies for service
  coverage, referrals and continuing education.
• Membership to the Private Nurse membership

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Nakuru Network

• A network of 35 clinics nursing/maternity homes

Main Cluster 15 clinic membership
Molo Cluster 15 clinic membership
Gilgil Cluster with 5 clinics Membership
1,187,039
Complement Public Sector FBO Service
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The Main Network Activities

• Merry-Go-Round funds.
• Conducts peer exchange visits to each others
  clinics This has been one of the most important
  activities cited by most of the members in Peer
  supervision
• Mobilization of resources from external sources
• Continuing Education for its

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Network Sustainability

• The providers own these facilities,
• Services are more affordable and sustainable.
• Improved quality, good care of the supplies and
  equipment of care has increased clientele,
• Established rapport with other stakeholders and
  community served were cited as the niche of the
  cluster.
• The Mary go round activity and adherence to its
  rules and has made the clusters more solid
  creating a family like environment.

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Supporting Factors

• Need to belong by and alliance
• Capacity Building in formalization and management
  of the networks.
• Recognition of the role of peer support
  supervision and facilitation
• Collaboration and Networking
• Commitment to serve
• MOH recognition of their contribution

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Challenges

• Coverage of facilities in the absence of the PAC
  trained providers since most of the facilities
  have only one provider trained in PAC.
• Irregular attendance of the monthly meetings by
  some members
• Declining Support Supervision agencies that
  facilitated formalization of the cluster.
• Fear of legal action against the members for
  offering PAC services affects record keeping
• Poor clients served who are unable to pay for the
  services
• Opportunities for PAC is not moving as fast as
  the cluster members would like and this is
  frustrating the members.

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Challenges- 2

• Innovations needed to maintain services to the
  needy communities at low cost.

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CONCLUSION

• Kenya private Nurse Midwives have demonstrated
  that they can expand quality services to
  underserved and needy RH service clients at low
  cost.
• They are located in the most needy localities,
  have the capability and need to be mobilites to
  reduce maternal and infant mortality.

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References

• PRIME II, The Right Provider at the Right Place,
  2003
• ESD, Private Nurse Midwives Networks of Kenya
  Best Practice