Kenya's Group Antenatal Care Model: Sustainability from the Word "Go"

Kenya's Group Antenatal Care Model: Sustainability from the Word "Go"

In the spirit of the 3,500-year-old Tao (Way) of Leadership, MSH works closely with local institutions and communities to create lasting and sustainable changes; changes that improve the health of people among the world’s poorest and most vulnerable groups.

And as the Tao indicates, sustainability starts with ownership, “The people will say, we have done it ourselves.”

Women in Kakamega County, Kenya are taking charge of their pregnancies, supporting their peers, and learning about healthy practices and self-care from skilled health providers. MSH’s Lea Mimba (“Take care of your pregnancy”) project, funded by UK Aid through the County Innovation Challenge Fund (CICF), tested an innovative group model for antenatal care (ANC) that responds to the needs and perspectives of women and front-line health providers. At six Kenyan health facilities, Lea Mimba provides a forum where pregnant women share experiences, learn birth planning and self-care practices, provide each other with emotional and social support, and receive essential health information from a skilled health provider, who is usually a nurse.

Since the design phase of the project, MSH identified strategies to support the integration of group ANC into Kenya’s health system and promote it's sustainability and expansion.

Co-Creating the Service Design

Using a human-centered design approach, in collaboration with Finland-based M4ID, MSH engaged women and frontline providers in health facilities and communities to ensure that the group ANC model is responsive to their needs and other relevant contextual considerations, with the ultimate aim to ensure uptake and long-term sustainability of the intervention.

Advocacy and Community Engagement

Sustaining group care at scale requires strong advocacy and community engagement with women, providers, and policymakers to ensure that this new model of care has buy-in from the outset and that there will be continuing support beyond the implementation period. Advocacy at all levels of the system and community outreach are essential elements to shift mindsets toward person-centered care and self-care. MSH advocated with the county health management team (CHMT) to increase the county’s financial and human resources investment in the model’s implementation.

At the community level, MSH recruited the support of community influencers—chiefs, religious leaders, teachers, among others—through community events to share information about Lea Mimba and stress the importance of ANC in supporting the health of mothers and newborns.

Building Capacity

MSH partnered with the Kenya Progressive Nurses Association (KPNA) who’s members supervise the health providers that lead group ANC sessions at various project sites, from referral hospitals to community health centers. Through its national network, KPNA can now share lessons from Lea Mimba and incorporate the model into their continuous professional development. MSH is transitioning KPNA’s responsibilities to the county’s reproductive health coordinators to provide continuous on-the-job training and supervise health providers in group ANC.  

Shaping National Policy

For any new health intervention to be successfully adopted and scaled, supportive policies and financing must be in place. MSH supported the national ministry of health and taskforce in revising the national ANC and intrapartum guidelines and in providing and synthesizing emerging evidence from our own research, as well as other published studies on group ANC. MSH also contributed to the revision of the national reproductive health policy in 2018 by successfully advocating for a reference to innovations in the recently approved policy, "Fostering innovative delivery modes that address current challenges," to provide a basis for adopting group ANC in national guidelines and county work plans.

Sharing Evidence for Scale

Understanding the health systems adaptations needed to take the group ANC model to scale is critical to ensuring that local partners can begin to actually implement it. Findings from the Lea Mimba evaluation will not only provide evidence on the retention, quality of care ratings, and improved knowledge and practice of healthy behaviors—but will also identify assets and barriers that may affect the operational feasibility, scalability, and sustainability of the group ANC model. MSH will share results from our evaluation with partners at the county and national level to help inform policies in support of group ANC.

Stay tuned for a summary of findings.