Kuria Annual Stakeholders Meeting

Over the past few months we have been working hard to improve our relationship with the Ministry of Health. We should no longer merely co-exist, we need to be allies in the war on communicable disease and preventable death and our development of a CHW (Community Health Worker) unit is directly inline with the Kenyan National Health Sector Strategic Plan.

As we’ve gained recognition on the district and provincial levels we are starting to receive invitations to ministry meetings and other NGOs are reaching out to us to combine efforts. Recently we attended an ActionAid sponsored Female Genital Mutilation strategy meeting and our CHWs partook in an Essential Health Service funded Maternal Health Baraza. Last week Nelly and I traveled to Kehancha, for the district’s ‘Annual Stakeholders Meeting for Maternal and Neonatal Health.‘

It was an opportunity to learn about the efforts of other NGOs in the area and to gain access to the most up-to-date Kurian health statistics – which are very hard to come by.

Despite the 8:00am scheduled start time, around 11:45 the district statistician took to the stage for a ‘year in review’ presentation.

To ease into the AOP (Annual Operation Plan) Performance Report for July 2009-2010, Samwell reviewed the Millennium Development Goals. He then focused on local stats specific to #4 (Reduce Child Mortality) and #5, beginning with the district demographics- there are 14,6,669 individuals in the district, 5% of which are under one-year old and 19% under five. 25% are of childbearing age.

The next set of information pertained to access to family planning. Anecdotally knowing the low rate of use in Nyametoboro and surrounding areas, the impressively high-recorded percentage of women using contraceptives struck me as fishy. He then noted that 51% of all under 5’s received Vitamin A supplementation thanks to five outreaches sponsored by a International NGO. Also higher than I expected, but certainly not unreasonable. Who am I to judge? I am not a statistician, and didn’t have all of the background information that informed this dataset.

But with the next slide all credibility was lost.  Samwell was pleased to announce that the MOH successfully vaccinated 118% of their target under 1s. How wonderful! But what was the targeted percentage?  I asked. His response: 100%. Wow! I was puzzled when the statistician did not use this opportunity to explain this odd piece of information, and immediately moved on to the next topic without further explanation. Dissatisfied with this, I raised my hand and suggested that perhaps the reason for this was that every under-1 had been vaccinated and some even twice. After calming down from a brief laughing fit he said, in a tone that insinuated my stupidity, “of course not! Children from Tanzania and other districts are sometimes immunized in Kuria.” This is well and good, immunize as many kids as possible, but please record where they are coming from.  Besides, in my opinion, there is absolutely no way that over 90% of Kuria’s under 1 population have been immunized.

Perhaps worse was the data on maternal deaths. According to the AOP there were two maternal deaths in 2008, three in 2009, and eight in 2010. For a country with a maternal morality rate of 5.6%, with the Nyanza province as it seems odd that the rate in Kuria West is so low. Turns out, they only accounted for deaths at the District Hospital, none of the other clinics or location hospitals, and it happened that the district hospital’s generator was broken during 2008 and 2009 so they were referring maternal complication cases to other facilities that had electricity.

You may wonder why this is happening. Along with inadequate recording procedures and materials, laziness, and misdiagnosis, it has become clear that there is a conflict of interests in the incentive system for rural facilities. The health workers want to report good statistics to be recognized as a worthy facility, but these fake numbers impede granting for support they actually need.

Though terribly frustrated that the MOH was knowingly presenting wrong data to local stakeholders, I am concerned about the implications of this publication which will reach international donors and the ministry at the national level, which is responsible for allocating funds. This data indicating that Nyanza is not in need of improved services impacts available assistance. Perhaps this is what accounts for Kuria being the forgotten district and this is what we are trying to change.