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KIBERA INTEGRATED HEALTH SERVICE DELIVERY MODEL Effectiveness of Ng’adakarin BAMOCHA model in improving access to ante-natal and delivery services among.

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Presentation on theme: "KIBERA INTEGRATED HEALTH SERVICE DELIVERY MODEL Effectiveness of Ng’adakarin BAMOCHA model in improving access to ante-natal and delivery services among."— Presentation transcript:

1 KIBERA INTEGRATED HEALTH SERVICE DELIVERY MODEL Effectiveness of Ng’adakarin BAMOCHA model in improving access to ante-natal and delivery services among nomadic pastoralist communities of Turkana West and Turkana North sub-Counties of Kenya Jillo Ali Jillo, Peter Ofware AT THE AMREF HEALTH INTERNATIONAL CONFERENCE November 2014

2 AREA BACKGROUND AND DEMOGRAPHICS  Turkana North and Turkana West of Turkana county with estimated area of 35,000km2.  Estimated population: 250,760  Women of childbearing age: 54,530.  Under 5s: 34,615.  80% of the population are Nomadic pastoralists

3 INTRO: NG’ADAKARIN BAMOCHA MODEL  Ng'adakarin: Migratory groups  Based on migratory routes of nomadic pastoralists of Turkana.  Has three main components: o Services at container clinics o Improved referral systems o Modified (fluid) community health units

4 MAPPED MIGRATORY ROUTES

5 MAPPED MIGRATORY ROUTES CONT’D

6 PROBLEM STATEMENT  Ng’adakarin BAMOCHA brings together health care at the facility level and a strong community based component  Aim: community access and are actively involved in the improved delivery of essential health interventions.  Migratory lifestyle places the community outside conventional static health systems  Specifically targets four key maternal and child health indicators: (i) ante-natal care (ii) skilled delivery (iii) family planning (iv) immunization

7 PROBLEM STATEMENT CONT’D  Focused Research- Empirical evidence of effectiveness missing.  Health road map for Turkana (2007) stakeholders to base HSP on Ng’adakarin BAMOCHA model.  Effectiveness of Model study necessary- o Accountability for donor and County Government funding o Health of 80% of Turkana Population at stake

8 RESEARCH QUESTIONS AND OBJECTIVE Questions  NB model on access to 4 th antenatal care  NB model on access to delivery under skilled care Objective To evaluate the effectiveness of the Ng’adakarin BAMOCHA model in improving access to maternal and child health care services among nomadic pastoralists of Turkana North and West sub-Counties

9 METHODS  Sample size: 384 women (Cochran’s formula)`  Data collection tools: HH questionnaire, FGD guide, KII guide  Data entry: Ms access  Data analysis: SPSS version 21 and Nvivo version 10

10 DEMOGRAPHICS Pre-intervention %, N= 382 Post-intervention %, N=400 Independent samples T-test (p-value) Age 15-19 years2.87.90.13 20-24 years20.828.6 25-29 years25.324.3 30-34 years30.316.8 35-39 years10.811.6 40-44 years8.36.1 45-49 years1.94.8 Mean28.0528.45 Std. deviation4.94.8 Education None90.886.60.15 Primary4.79.3 Secondary+3.12.0 Not stated1.42.0 Demographic Christians80.676.80.15 Muslim0.61.1 Traditional13.69.5 Other1.91.4 Not stated3.30.9 Number360441

11 ANTE-NATAL CARE Significant at 0.05 - * Significant at 0.01 - ** Significant at 0.001 - *** NumberPre-intervention Frequency (%) Post-intervention Frequency (%) p-value Once33 (14.3%)32 (12.1%)0.12 Twice31 (13.4%)65 (24.5%)0.02* Three times42 (18.2%)57 (21.5%)0.05* Four times119 (51.5%)111 (41.9%)0.04* Not stated6 (2.5%)--

12 KNOWS ABOUT ATTENDING ANC 4+ TIMES

13 DISCUSSION  4 th ANC care access similar to national average, KDH 2009  Trend of dip in ANC uptake and pattern similar to national pattern, KDHS 2003 and 2009  Level of education influences uptake of ANC  Gaps exists between level of knowledge on service and uptake

14 Significant at 0.05 - * Significant at 0.01 - ** Significant at 0.001 - *** Place of Last Delivery Place of Delivery Pre-intervention N(%) Post- intervention N (%) P-value Home317(89.5%)318(79.5 %)0.04* Away from home15(4.2%)10(2.5%)0.12 Health facility22(6.2%)66(16.5%)0.03* Other/Not stated-5(1.3%)-

15 Significant at 0.05 - * Significant at 0.01 - ** Significant at 0.001 - *** Assistance During Delivery Assistance Pre-intervention N (%) Post intervention N (%) P-value Skilled attendants (Midwife/Nurse/doctor) 20(5.6%)65(17.7%)0.03* TBA27(7.5%)74(20.2%)0.03* Relatives/friends142(39.4%)168(46.0%)0.06 Self162(45.0%)59(16.1%)0.01** Not stated9(2.5%)--

16 DISCUSSION  Skilled delivery below national average, KDHS 2009  Increase in TBA assisted delivery cause for concern; direct delivery vs referral agents  Preference for TBA assisted delivery- geographical access, capacity of C/clinics, costs involved.

17 CONCLUSION Improvement in access to and utilization of the targeted health care services:  Antenatal care: Significant impact  Skilled delivery: Significant impact

18 RECOMMENDATIONS  ANC- ACHWs involvement and capacity building o Cross-cutting: Girl child education; mobile schools and boarding facilities o Container clinic: Existing container clinic; medical supplies  Deliveries: provision of maternity waiting homes

19 FURTHER RESEARCH RECOMMENDATION  Cost effectiveness study of the Ng'adakarin BAMOCHA model

20 ACKNOWLEDGEMENTS  European Commission  Big Lottery Fund  Turkana North and West sub Counties communities and Health Management Teams

21 THANK YOU


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