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Cuide da mamãe: Parteiras Comunitárias Aumentam o Acesso PF/RH em Casa no Quênia


Nossos colegas da Amref compartilham como a rede Tunza Mama melhora o status socioeconômico das parteiras enquanto impacta positivamente os indicadores de saúde de mães e crianças no Quênia.

Agora mais do que nunca, 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 Cuide da mamãe, 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

Cuide da mamãe 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, recém-nascido, and child health (MNCH) 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 Cobertura Universal de Saúde (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.

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. Além disso, 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 (MISAU). Por exemplo, 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.

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, e 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.

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 (Quênia) where 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 do 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, dentro 2017 about 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 mostrando a uma mãe como realizar exercícios nas costas durante a gravidez.

Marygrace Obonyo mostrando a uma mãe como realizar exercícios nas costas durante a gravidez.

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: No passado, 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, acessível, e acessível.
  • The power of social media: Sobre 70% of mothers have come to know of Tunza Mama through Facebook, Twitter, and Instagram; Portanto, 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 [dentro] it and I love it: It is personalized, acessível, 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.

“She (the midwife) has been amazing—she gave me assurance that everything will be fine…I [purchased] the full package because I believed [dentro] it and I love it: It is personalized, acessível, 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.

Desafios

Personalized MNCH care is not common in the Kenyan context; Portanto, 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.

Pensamentos finais

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.

Cuide da mamãe: Parteiras Comunitárias Aumentam o Acesso PF/RH em Casa no Quênia
Sarah Kosgei

Gerente de Redes e Parcerias, Amref Saúde África

Sarah é Gerente de Redes e Parcerias do Institute of Capacity Development. Ela acabou 10 anos de experiência na liderança de programas multipaíses voltados para o fortalecimento da capacidade do sistema de saúde para uma saúde sustentável no Leste, Central, e África Austral. Ela também faz parte do secretariado Women in Global Health – Africa Hub domiciliado na Amref Health Africa, um Capítulo Regional que fornece uma plataforma para discussões e um espaço colaborativo para liderança transformadora de gênero na África. Sarah também é membro da Cobertura Universal de Saúde (UHC) Recursos Humanos para a Saúde (RH) subcomitê no Quênia. Ela é formada em Saúde Pública e tem um Mestrado Executivo em Administração de Empresas (Saúde global, Liderança e gestão). Sarah é uma defensora apaixonada dos cuidados de saúde primários e da igualdade de gênero na África Subsaariana.

Priscilla Ngunju

Project Coordinator, Amref Saúde África

Priscilla Ngunju is the Project Coordinator for the Kenya Innovative and Sustainable Solutions for Midwives Education and Employment (KISSMEE) project at Amref International University. Em seu papel, Priscilla leads a team of dedicated staff in the initiation and registration of the Tunza Mama Network and ISOMUM institute, the “babies” of the KISSMEE project. Priscilla holds a Bachelor’s degree in Nursing Sciences and a Master’s degree in Public Health from the University of Nairobi. She is also an alumna of the prestigious Women in Leadership Program from Strathmore Business School. Priscilla is driven by the results of impactful work, especially among women and children.

Dr.. Micah Matiang'i

Dean of School of Medicine Amref International University, Senior Lecturer

Dr.. Micah Matiang'i is a Health Development and Human Resource for Health (RH) training resource person with experience spanning over 15 years in various health development programmes and HRH training in ECSA region. Skilled in designing and implementation of innovative MNCH and HRH training programmes in resource constrained settings, he has implemented HRH and MNCH programmes in Tanzania, Malawi, Zimbábue, Zâmbia, Uganda, Quênia, Etiópia, and South Sudan with Amref, UNFPA, MSH, Usratuna, and Canadian Midwives Association. Dr.. Matiang'i is a creative and adaptable leader in grant writing and management, curriculum development, and Health Systems Management. He's keen on implementation of value-adding health programs fueling transformative change at organizational and community level—able to conceptualize and execute program vision from start to finish, while adapting to changes and shifting priorities. With experience in leading cross-functional teams in delivering strategic initiatives proven to improve systems, processos, and overall results, Dr.. Matiang'i is usually fascinated with designing and carrying out health systems and implementation research in health development programmes. He's well experienced in development and management of partnerships, linkages, and collaborations and also well experienced in carrying out organizational capacity assessments (OCA) using evidence-based tools, including developing growth and development trajectory plans post-assessment. Dr.. Matiang'i is both a commonwealth and PRP policy communication fellow.

Alex Omari

Oficial de KM da África Oriental, Conhecimento SUCESSO, Amref Saúde África

Alex é o Responsável Técnico de Planeamento Familiar/Saúde Reprodutiva no Instituto de Desenvolvimento de Capacidades da Amref Health Africa. Ele trabalha como o Diretor Regional de Gestão do Conhecimento (este de África) para o projeto Knowledge SUCCESS. Alex acabou 8 anos de experiência em saúde sexual e reprodutiva de adolescentes e jovens (AYSRH) projeto do programa, implementação, pesquisar, e advocacia. Ele é atualmente um membro do Grupo de Trabalho Técnico para o programa AYSRH no Ministério da Saúde no Quênia. Alex é membro eleito da Royal Society for Public Health (FRSPH) e um ex-coordenador de país do Quênia para a International Youth Alliance for Family Planning (IYAFP). Ele é bacharel em ciências (Saúde da população) e Mestre em Saúde Pública (Saúde reprodutiva) da Universidade Kenyatta, Quênia. Atualmente cursa seu segundo mestrado em Políticas Públicas na Escola de Governo e Políticas Públicas (SGPP) na Indonésia, onde também é estudioso de redação de políticas de saúde pública e saúde e contribuidor do site para o Strategic Review Journal.

Diana Mukami

Diretor de Aprendizagem Digital e Chefe de Programas, Amref Saúde África

Diana é a Diretora de Aprendizagem Digital e Chefe de Programas do Instituto de Desenvolvimento de Capacidades da Amref Health Africa. Tem experiência em planejamento de projetos, Projeto, desenvolvimento, implementação, gestão, e avaliação. Desde 2005, Diana esteve envolvida em programas de educação a distância nos setores de saúde público e privado. Estes incluíram a implementação de programas de treinamento em serviço e pré-serviço para profissionais de saúde em países como o Quênia, Uganda, Tanzânia, Zâmbia, Malawi, Senegal, e Lesoto, em parceria com os ministérios da saúde, órgãos reguladores, instituições de formação de profissionais de saúde, e entidades financiadoras. Diana acredita que a tecnologia, usado da maneira certa, contribui significativamente para o desenvolvimento de recursos humanos responsivos para a saúde na África. Diana é formada em ciências sociais, uma pós-graduação em relações internacionais, e um certificado de pós-bacharelado em design instrucional da Athabasca University. Fora do trabalho, Diana é uma leitora voraz e viveu muitas vidas através dos livros. Ela também gosta de viajar para novos lugares.

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