'Beyond Zero' clinics: How multi-million shilling initiative flopped

Halima Hassan is writhing in pain. Labour pains. Blood. Emergency. It’s 12pm. 

In the scorching sun in Dololo village, Garissa County, the mother of five is stepping in a maternity ward for the first time ever.

She had to walk five kilometres before getting here, the nearest health centre from her home. 

Hiring a motorbike at Sh1, 500 would have been costly and risky to her. But even motorbikes are not readily available in the area. 

Her husband Hussein Mohammed made several calls to get a motorbike and the earliest one from Garissa town could only get to the village after 50 minutes. 

At exactly 2.20pm under a dreaded mathenge thorn tree, the piercing cry of a newborn rents the air. A baby boy is born with the help of Halima’s sister-in-law. Unfortunately, three hours later, the baby dies.

The mother was fortunate. She survived one of the riskiest experiences a woman and her child will face: childbirth. 

While Halima survived, too many others did not. At Dololo village, women are normally faced with a tough choice —  give birth at home or on the way to hospital. On most occasions, many children are either by roadside delivery or home delivery. 

Also Read: Nurse Rashid Abdi's selfless act warms hearts of Kenyans

Even if they are aware of their delivery dates, women in this village cannot report to the hospital before labour starts because the facility does not have enough beds to accommodate them. 

After giving birth, they are discharged within 24 hours to give space for other women. The labour room can only accommodate one mother at a time, hence the reason mothers among Garissa’s rural communities still prefer to give birth at home. 

Far too often, pregnant women including Halima fail to receive the high-quality, respectful, life-saving care they deserve before, during and after birth because they have been failed by the system. They have no luxury of choosing where to give birth.   In all her pregnancies, she told Healthy Nation that she has never spotted blood. She has given birth to all her first four babies at home. However, when she saw blood, she sensed danger. Luckily, she did not develop complications that warranted the attention of specialists. 

“I would be dead by now. May my son rest in peace...,” a dejected Halima says. 

Why a woman can give birth at home in 2022 remains a puzzle yet the government launched a Beyond Zero clinic initiative that saw 52 clinics given to all the 47 counties eight years ago. 

Mubarak Hussein, the area chief, says the villagers live by the grace of God and getting a means of transport, an ambulance or a motorbike is difficult. 

“I wish they would have made use of the mobile clinics donated to us, we were very happy when they came here for three days, it really helped. We have not seen them again after that,” says Hussein. 

He says if it is impossible to have the clinic in the village, then the county government should consider building a health facility near the village. 

Early this year, a family in Murang’a buried a young woman and her baby who died in the most unfortunate of circumstances. 

Caroline Mumbi, 23, was killed when a boda boda that was taking her to hospital for delivery was involved in a road crash. 

Her husband had advised her to take a boda boda because it was the most affordable and convenient mode of transport available to them. 

While this is an isolated incident, it puts the spotlight on the rarely discussed issue —  maternal and child mortality. 

According to data from the Ministry of Health, one in 38 Kenyan women is at risk of dying from childbirth complications such as excessive bleeding or obstructed labour.

At least 6,000 women die from pregnancy-related complications in the country every year, way above the global average. 

While safe motherhood is easily achievable with the right policies and investments, Kenya’s investment in the sector has yielded little results. The country still grapples with hurdles that lead to maternal deaths. 

Dr Edward Kariithi, senior service delivery technical adviser at PATH, says most maternal deaths can be prevented if women received antenatal care to monitor the progress of the pregnancy and deliver in a health facility with qualified personnel and the right equipment. 

“This is critical to take care of any arising emergencies in good time. Safe motherhood is easily achievable with the right policies and investments. So far, Kenya has had quite a number of investments in the sector with little results,” says Dr Kariithi. 

Also Read: A decade of mixed fortunes for healthcare system

An absolute lack of effective ambulance services is also evident, particularly in remote parts of the country. 

So when First Lady Margaret Kenyatta’s Beyond Zero campaign raised millions of shillings for the purchase of ambulances in the counties to take women to hospital for delivery, many mothers celebrated, but the buoyancy would soon fade. 

Regrettably, maternal deaths are still high despite the promise that came with the initiative – to free Kenyan mothers from the insecurities of maternity care. 

The Beyond Zero programme, which criss-crossed the country issuing each county with a mobile clinic, was aimed at curbing maternal and infant deaths as well as promoting child health. But the opposite has become the reality.  If the clinics in Murang’a and Garissa counties were operational, Caroline would be a happy mother and a living wife to her husband. 

The two cases are a reflection of some of the problems with the health system overall in that the poor often struggle to access care. Rural communities are often left out on routine primary care, maternity care or emergency care. 

Beyond Zero, launched in January 2014, was registered as a private company and the first clinic was taken to Taita Taveta; with the rest of the 46 counties getting mobile clinics by the end of 2016.

In Nairobi, 11 portable clinics were installed in Kibera’s informal settlement, nine of which are still standing but not working. Two of the clinics were destroyed. Garissa was the 39th county to be handed the mobile clinic. However, since its launch in the county, Halima and women in Dololo village only saw it twice, and this was the first year it was launched. Since then, it has been grounded.

The clinic served all the seven sub-counties and in a year, it made only two trips per sub-county. 

While the initiative has played a role in reducing child maternal mortality, an important step in the right direction, the work is far from done. 

In many cases, women die of complications during birth because they are not able to get to hospital on time, thanks to the long distances to the facilities yet the clinics are grounded in almost all the counties 

In cases where distance is not an issue, then basic medical supplies are often hard to find in the clinics or there are no workers or equipment. Prenatal and maternity care are a priority, yet the mothers lack transportation to go for follow-ups. 

The mothers are left in the care of traditional birth attendants. There is no doubt they are a much-needed resource in areas like Dololo. Unfortunately, not all of them are skilled enough to handle cases and complications. 

Investigations by the Healthy Nation in some of the counties reveal that the clinics are grounded, with many counties citing inadequate health personnel, allowances, drugs and lack of insurance, fueling the trucks and management cost. 

Some counties struggling to employ medics, pay their allowances and at the same time fuel the trucks have since requested the national government help to run the clinics. 

The clinics need drivers, nurses, clinical officers, clerks and lab technicians who work in shifts. 

The mobile clinics fitted with three consultation rooms, a laboratory and a pharmacy, are mainly used in the counties for emergency services, distribution of drugs and nets as well as in the provision of basic health services. 

Counties are allocating amounts ranging from Sh1 million to Sh10 million to run the clinics a year but there is no sign of improvement of maternal care services. 

In Tharaka Nithi County, services have halted due to lack of fuel, drugs and allowances for nurses. The truck is grounded.

In Siaya, Kisumu, Homa Bay, Vihiga, Kitui, Marsabit, Kericho, Bomet, Nakuru, Lamu, Mandera, Turkana, Narok, Bungoma, Nyamira, Kitui, Nyandarua, Nyeri, Murang’a, Kisii and Meru,  the trucks are grounded. 

In Kitui County, two mobile clinics under the ‘Beyond Zero ‘plan have been grounded for the longest time now.

Two reliable sources in the Health Department have separately cited budget constraints. The staff used to go for weeks without allowances until they gave up, according to the sources. 

Kilifi County Health Executive Charles Dadu said financial challenges are hindering the smooth operations of the clinics. “The Beyond Zero clinic is still alive, mainly used in targeted campaigns. However, the frequency of the use is not as high as we would desire because of operational costs, especially in hard-to-reach areas,” he said. 

“We need to have specific staff attached to it, and our numbers currently would not allow an everyday schedule and expenses such as fuel and allowances for the staff due to limited funds,” said Mr Dadu. 

In other counties checked by the Healthy Nation including Makueni, Tana River and Kwale, the trucks are used for outreaches and public health campaigns. 

Kwale Nursing Officer Edward Mumbo said the mobile clinic usually moves on ‘Beyond Zero Action’ days to various locations between Kinango, Lungalunga, Msambweni and Matuga . 

The sponsors

For the project, the First Lady attracted high profile sponsors by organising fund raising events but the leaked information shows that the initiative has also benefited from tax payers’ money

The Ministry of Health and the Presidency has since allocated some money to the initiative. In 2014, immediately after the launch, five organisations donated cash and equipment valued at Sh31.3 million to boost the ‘Beyond Zero’ campaign.

The Ford Foundation, through its Regional Representative Maurice Makoloo, gave Sh15 million, while the Housing Finance Corporation of Kenya's board Chairman Steve Mainda gave Sh10 million. China's Ambassador Liu Xianfa donated infant incubators valued at Sh2.3 million. 

Other donors included Murang’a County government through Governor Mwangi wa Iria (Sh2 million) and the Miller Foundation through the chairperson, Cecil Miller, (Sh2 million). Spouses of Cabinet Secretaries also donated Sh600,000 towards the  drive. 

In the first edition of the marathon, the initiative 'First Lady’s Half Marathon' raised over Sh200 million, which went to the purchase of 20 mobile clinics.  On the second edition of the 'First Lady’s Half Marathon' at the scenic Karura Forest, about Sh600 million for her ‘Beyond Zero’ campaign was raised. 

An estimated Sh288 million was raised during the third edition of the First Lady’s Half Marathon held on March 6 in Nairobi. In 2015, donations totalling Sh46 million were presented to the First Lady at the Nyayo Stadium, with the Commercial Bank of Africa donating Sh25 million.

In 2016, the First Lady pitched for a Sh200 million kitty for her Beyond Zero campaign when she attended Southwest College of Naturopathic Medicine in America.

In the same year, Deputy President William Ruto donated Sh17 million, the Ministry of Health gave Sh3 million and Kakamega County Sh1 million. 

Basically, government officials gave our taxes to a charity, to support work that the government itself should be doing. 

Even with the government spending millions of money on initiatives that never picked up, the country has never had a decline in maternal and child mortality.

According to the just released 2022 Economic Survey, more women are still giving birth in the community and last year, over 1.2 million live births happened in the community, an increase from the previous year that recorded 1.1 million live births. 

But the survey also indicates that the total number of deliveries increased by 5.7 per cent to 1.2 million in 2021. 

In Tana River, Wajir, Marsabit, Turkana, West Pokot and Samburu, more than two-thirds of live births in the past five years were not attended to by skilled individuals or delivered at a health facility. Hence, increasing vulnerability to maternal death and child mortality in these areas. 

Increasing access to health facilities would accelerate progress in reducing deaths among children and their mothers, and improving their health. The need for mobile clinics is great, especially in regions inaccessible with health facilities. But this begs the question, isn't this the work of the government and not charity? Isn't this the reason taxes are paid? 

Dr Kariithi observed that Kenya must increase access to high-quality services in every county because childbirth and the early days of life should not be filled with fear.  “Women need reliable access to care before pregnancy, throughout pregnancy, during childbirth, and following it, no matter where they live. Skilled attendants must be part of childbirth,” he said, adding: 

“A woman in Marsabit or Turkana deserves the same quality of care as a woman in Mombasa or Nairobi. Kenya has the opportunity to lead the continent by ending preventable maternal, newborn, and child deaths.”

But one question is ringing in the minds of most mothers — is this the end of ‘Beyond Zero’ as we know it? That is because President Uhuru Kenyatta is leaving office in August and chances are high that the First Lady may not guarantee the project’s continuation.

[email protected]