As 2019 begins, it’s an opportunity to reflect on 2018. During the Christmas holiday, the nativity scene of Mary and Joseph in a manger reminded me of our maternal child health indicators. No official records exist, but perhaps Mary too faced perhaps worse maternal and neonatal mortality risks than exist now.
Historians suggest that Joseph took Mary “home” to deliver close to his relatives in Bethlehem, a not uncommon occurrence among urbanites in informal settlements.
Traditionally, this is for the provision of family support for mothers. Their trek of about 105km, was quite arduous for a pregnant woman, even on a donkey.
Last year, as part of a series of articles on mobility and health, I had the privilege to traverse the city, logging a total of 1,786km assessing challenges as well as the potential impact of road projects to healthcare in Nairobi’s poorest neighbourhoods.
Most of the roads were funded by the World Bank, African Development Bank and Kenya Urban Roads Authority with a constellation of shorter cabro and bitumen ones done by constituency development fund and MCAs’ ward kitties.
Though not intended reasons for building roads, an overshadowed impact of such projects is what accessibility contributes to health outcomes.
This powerful yet overlooked part ought to be part of their narrative. Not just the length of roads built. The human element resonates better with people on the ground. For pregnancy-related complications, ease of mobility is particularly important, given the sometimes sudden and dramatic turn of events from ordinary to potential catastrophe around childbirth.
Given the time of labour, the majority of home deliveries are at night when insecurity and a lack of roads restrict movements of patients.
Proximity is king and when a 45-minute walk at night is translated to a 10-minute ride, the probability of delivery in a health facility rises. Ease of mobility for medics and community health workers also is important.
One series of five-year data analysis indicated that an average of 37 per cent deliveries occurred outside the hospital nationally.
In urban areas, while 55 per cent of deliveries are in public health facilities, 17 per cent still occur at home. This segment could be a big chunk of informal settlement dwellers.
In one of the facilities evaluated, metrics like antenatal care attendance frequency, distance radius to a facility delivery, all correlated with the lack of or presence of good roads.
In the Ngomongo-Babadogo area, a cul de sac and a small river that previously prevented mothers from accessing services 500m away. An ongoing tarmac road is already showing impact with mothers now moving easily. We have more to complain about, but on this metric, the Nairobi governor, MCAs and MPs serving such areas deserve a pat on the back. My best takes are Mathare-Huruma, Congo-Kawangware, Kasarani-Githurai, Dandora-Kariobangi-Korogocho link roads.
Happy New Year to this column’s readers!