1. COUNTRY ACCOUNTABILITY FRAMEWORK CONSULTATIVE MEETING ON ENDING PREVENTABLE MATERNAL DEATHS IN KENYA BOMA HOTEL NAIROBI 27 TH -28 TH AUGUST 2014 HEAD DIVISION OF FAMILY HEALTH

2. BACKGROUND September 2010, the Secretary-General of the United Nations launched the Global Strategy for Women's and Children's Health. GOAL Protect 120 million children from contracting pneumonia Prevent 88 million children from stunting Prevent 33 million unwanted pregnancies Prevent 15 million deaths of children under the age of 5 Prevent 570,000 deaths of pregnancy related complications

3. 1. Vital events (CRVS) 2. Health indicators & equity 3. Innovation 4. Resource tracking 5. Country Compacts 6. Reaching Women/Children 7. National oversight 8. Transparency 9. Reporting aid for Women/ Children’s health 10. Global Oversight COMMISSION RECOMMENDATIONS Country Actions Global Actions Birth and death registration Monitoring of results Maternal death surveillance & response Accountability Framework eHealth & innovation Monitoring country resources Advocacy and action Monitoring results Tracking resources Global review (iERG) The strategic work plan Concluding compacts From recommendations to actions

4. THE 7 KEY COUNTRY THEMATIC AREAS 1.Monitoring of births, and deaths through civil registration and vital statistics. 2.Monitoring of results (strong M&E, data quality verification & transparency. 3.Maternal death review( MPDSR)and quality of care evaluation in health facilities 4.Use of E-Health and Innovation (ICT) in health information systems 5.Tracking of financial resources – National health expenditure tracking, RMNCH sub-accounts 6.Annual review – e.g. annual health sector review including all relevant stakeholders 7.Advocacy and action – political commitment, community participation, National Countdown conferences, parliamentarians,…

5. CAF MILESTONES AND PROGRESS FEB 2012-Tanzania regional workshop Feb 2013-National stakeholders workshop April 2013- catalytic funds disbursed Sept –Oct 2013 County workshops held 2014- Midterm assessment conducted

6. How Kenya Prioritized Catalytic Fund USD 250,000

7. CAF PROGRESS/ ACHIVEMENTS Civil registration, vital statistics (CRVS) assessment completed, plan developed Strategic Plan for the civil registration department was developed. The MOH in partnership with the Civil Registration.

8. CAF PROGRESS CTN Maternal death surveillance and response (MDSR) system in place Kenya developed tools for MPDSR. Training of 11 selected pre- service training institutions scheduled. Countrywide audit of MPDSR implementation done – analysis on-going. Monitoring and Evaluation Consensus on the 11 core indicators and the data sources. Kenya is developing a roadmap for strengthening M&E.

9. CAF PROGRESS National eHealth strategy Both the national e-Health policy and strategy were developed. Four quarterly National e- Health/m-Health Forums convened by MOH. Country reporting on health expenditure by financing source The country was able to disseminate the findings of NHA 2010 and 25 officers were oriented on the Social Health Accountability 2011.

10. CAF PROGRESS CTN Rights based law and policy assessment completed for RMNCH  Enforcement of Constitution of Kenya 2010 provisions for reproductive health.  Taskforce formed to provide technical input for development of RMNCH legislation.  Legal drafting on-going prior to forwarding for Cabinet review and Parliamentary debate. National health sector review  Last Health Summit held in 2012.  2013 Annual health review conducted but not validated.

11. Political leaders engaged in RMNCH Head of State’s directive on Free Maternity Services in all public health facilities effective 1 June 2013. Kenya First Lady’s ‘Beyond Zero Campaign’ for MNCH and EMTCT. Campaign has been replicated by spouses of County Governors in all 47 counties.

12. MPDSR Audit Preliminary Report Coverage 15 high maternal mortality burden counties 75 facilities – county referral, Sub county, Health Center and Dispensaries

13. Data for Jan – Dec 2013 Maternal Deaths 243 by facilities while Civil Registration captured 258 Perinatal deaths 3,790 at facilities All deaths reported at facilities 23,354; while the Civil Registration Dept reported 23,725

14. Reporting of cause of death not complete “They will say that the mother just died, or say she died of something else. A woman who dies with a baby in her womb becomes such a big issue. So that information is just concealed. Or they refuse to say it” FGD Respondent. Any death that occurred outside the facility e.g. on transit to facility are not reported

15. Challenges – why maternal deaths – Lack of supplies and equipment to facilitate health workers’ – Gaps in referral system eg lack of ambulances for emergencies – Poor access to facilities, therefore mothers resort to deliveries at home – Misconceptions around facility deliveries – Irregular facility level maternal death reviews

16. CAF RECOMMENDATIONS Support for development of advocacy tools for RMNCH. Support for strengthening of capacity to conduct annual Data Quality Assessment. Strengthened capacity for conducting community reporting and verbal autopsies of maternal and perinatal deaths.

17. RECOMMENDATIONS CTN Support for scaling up of e-health/m-health capacity building activities to additional sites. Resource mobilisation from stakeholders to support the catalytic fund

18. Who is accountable?? Everyone is accountable to improving maternal and child health “The accountability framework brings together different departments that normally don’t collaborate. “It made people talk to each other. It has been a shift of paradigm. When you sit more with people, you learn to know their business.”

19. Indeed No woman should die while giving life !!!