Tunza Mama: Les sages-femmes communautaires améliorent l'accès à la PF / SR à domicile au Kenya

Maintenant plus que jamais, we need midwifery services in the community. With the COVID-19 pandemic, the availability of essential health services has been strained. Despite these challenges, we have increasingly seen nurses and midwives step up to offer care at the grassroots level. This piece summarizes how Tunza Mama, a health social enterprise by Amref International University, improves the socio-economic status of midwives while positively impacting the health indicators of mothers and children in Kenya. We assert to decision makers and technical advisors that midwives need support too and that we need to encourage their innovative methodologies to reach more mothers and children in the country, especially during these unprecedented times of COVID-19.

About Tunza Mama

Tunza Mama is a Swahili phrase meaning “to care for or nurture a mother.” The Tunza Mama network is a health social enterprise network, implemented in Kenya, geared at giving back to midwives while improving the health of mothers and their children. Tunza Mama has been in operation since May 2018, offering health education and accurate dissemination of health information to women of reproductive age in the comfort of their homes. The mothers/clients pay a small fee to have these services at their homes. Midwives are empowered with valuable skills in entrepreneurship, business development, and current maternal, nouveau née, et la santé des enfants (SMNE) care—for example, professional coaching on childbirth preparation techniques, lactation, birthing, weaning, and postnatal self-care.

Tunza Mama is responsive to the current global, regional and national demand for Couverture sanitaire universelle (UHC). Though this model has been in existence since 2018, it is now more useful than ever, as normal service delivery at health facilities have been disrupted due to the COVID-19 pandemic. This service is crucial to promoting health and preventing maternal, newborn and child ailments and mortality.

Marygrace Obonyo teaching mothers about breastfeeding practices in Kisii County.

How Does Tunza Mama Work?

Midwives from both the private and public sectors join Tunza Mama to offer voluntary family planning and reproductive health (FP / RH) care to women in the comfort of their homes. The midwives first undergo additional training in newborn and child nutrition for the first 1,000 days, applied MNCH practices, and business and entrepreneurship skills. As there are few midwives to begin with, to ensure we do not create a further shortage by taking them away for training, we leverage technology. Training is done through mobile and eLearning formats, meaning the midwives can still build their skills even as they continue to offer care in their respective health facilities. Any demonstration sessions are held with trainers at their health facilities to improve skills such as IUD insertion.

The midwives then undergo mentorship sessions with trainers at a local health facility, where they learn how to interact with pregnant women, mothers, and infants to build their communication skills. en plus, they offer health education sessions as part of birth preparation classes as their mentor observes and guides them. During the pandemic, all midwives are adhering to the current guidelines provided by the Kenya Ministry of Health (MOH). Par exemple, Tunza Mama midwives comply with infection prevention measures by wearing protective gear and maintaining social distance when they visit mothers at their homes. There is also a COVID-19 short course for health workers offered by the MOH and Amref Health Africa. The nurses/midwives earn up to 16 credit points for completing the course, bringing them closer to the 40 credit points required for license renewal.

Lydia Masemo demonstrating the use of a yoga ball to exercise during pregnancy.

Community Midwifery Regulation

Once the training and mentorship are completed, the Nursing Council of Kenya offers the midwives Community Midwifery licenses to enable them to offer services to mothers in their communities. The services offered by Tunza Mama include birth preparation classes, postnatal support, and complementary feeding support, as well as postnatal nursing care. So far, 558 women have benefited, et 62 mothers received these services over the past month.

The mothers served by Tunza Mama come from urban and peri-urban locations. The majority are working mothers who are also first-time mothers. They pay an average fee of KSh 2,000 (USD 20) for one session, which runs from 1.5 hours to 2.5 hours. Clients pay the fee out of pocket to the Tunza Mama bank account; the midwives then receive 95% of the fee, while 5% is retained to run the network. On a quarterly basis, the midwives offer free sessions to mothers from poor urban areas who cannot afford the full fee.

Susan Kerubo, a beneficiary of Tunza Mama services in Kisii, holding her son.

Putting Tunza Mama in Context

The project is embedded in a low- to middle-income country (Kenya) où 65% women have access to skilled birth attendants. In the same context, health facilities have a shortage of midwives (2.3 midwives per 10,000 people) because the government lacks the finances to employ the 3,000 comprehensive midwives who graduate annually from tertiary institutions. The limited access to skilled birth attendants is reflected in Kenya’s maternal mortality ratio de 362/100,000 live births and neonatal mortality ratio of 26/1,000 live births. This shortage of midwives in health facilities has pushed working women to seek highly specialised care from obstetric specialists in the private sector, denying them access to knowledge and skills on the basics of MNCH and self-care. According to WHO, dans 2017 à propos 86% of global maternal deaths were from Sub-Saharan Africa and Southern Asia.

The expected outcome of the project is to reverse the emerging trend of limited access to quality health education and personalised MNCH care for working mothers. It also provides an entrepreneurship opportunity for midwives to individually reach women across all social-economic classes.

Marygrace Obonyo montrant à une mère comment faire des exercices pour le dos pendant la grossesse.

Lessons Learned from Tunza Mama

• Innovative learning methods: Use of digital learning (mobile and eLearning) by the midwives has enabled them to interact with the content at any time, which has enhanced their learning and reduced face-to-face session time by 75%. This way, learning happens and no artificial shortage of midwives occurs.
• Mentorship: This is important in the training of a midwife. Mentoring provides support to the midwives during real-life experiences with the clients (mothers), which builds their confidence and improves their skills.
• A midwife is a mother’s ally: Dans le passé, the midwife was feared: She represented a tough, harsh professional, especially during hospital deliveries. This perception contributed to Kenya’s low rate of skilled birth attendants. A positive image of the midwife is important for uptake of voluntary family planning and RH care and attracting mothers to Tunza Mama’s services. The midwife is viewed as an ally/caregiver or Perinatal Educator who is accessible, disponible, and affordable.
• The power of social media: Plus de 70% of mothers have come to know of Tunza Mama through Facebook, Twitter, and Instagram; par conséquent, they can dial a midwife or reach out for assistance easily.
• Better maternal outcomes: More mothers are prepared for childbirth—for example, they can breathe through labour as guided by the midwife. Challenges such as cracked nipples during breastfeeding have been reduced. Mothers’ anxieties during weaning have been alleviated, since the midwife prepares the baby’s first meal with the mother present during the first feed.

“She (the midwife) has been amazing—she gave me assurance that everything will be fine…I [purchased] the full package because I believed [dans] it and I love it: It is personalized, accessible, and offers me confidence thanks to a mother figure.” — Elsie Wanjiku, young mother of a 2-month-old boy and a Tunza Mama client in Nairobi County.

Challenges

Personalized MNCH care is not common in the Kenyan context; par conséquent, uptake of Tunza Mama’s services has grown slowly. This is also a paid program for which the mother needs to pay a fee to the midwives, and so only the middle class can currently afford to utilize it. There is a need for technical advisers and decision makers to ensure this service is subsidised to reach all marginalised communities. As Tunza Mama is also available in only two counties (Nairobi and Kisii), there is a need for scale-up.

Dernières pensées

Community midwifery care is important to mothers, especially during the current COVID-19 pandemic. Inasmuch as we hope for continuity of essential care at health facilities, mothers are shying away from hospitals: the number of antenatal care appointments has dropped, home deliveries have increased, and unplanned pregnancies are inevitable. Midwives should therefore adapt the Tunza Mama model to offer voluntary FP/RH care in the comfort of mothers’ homes, and the government should incentivize these midwives for the extra care they are offering.