kibera integrated health service delivery model effectiveness of ng’adakarin bamocha model in...

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 KenyaJillo Ali Jillo, Peter Ofware

AT THE AMREF HEALTH INTERNATIONAL CONFERENCE

November 2014

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

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

MAPPED MIGRATORY ROUTES

MAPPED MIGRATORY ROUTES CONT’D

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

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

fundingo Health of 80% of Turkana Population at stake

RESEARCH QUESTIONS AND OBJECTIVE

Questions

NB model on access to 4th 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

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

DEMOGRAPHICS

Pre-intervention%, N= 382

Post-intervention%, N=400

Independent samples T-test (p-value)

Age15-19 years 2.8 7.9 0.1320-24 years 20.8 28.625-29 years 25.3 24.330-34 years 30.3 16.835-39 years 10.8 11.640-44 years 8.3 6.145-49 years 1.9 4.8Mean 28.05 28.45Std. deviation 4.9 4.8EducationNone 90.8 86.6 0.15Primary 4.7 9.3Secondary+ 3.1 2.0Not stated 1.4 2.0DemographicChristians 80.6 76.8 0.15Muslim 0.6 1.1Traditional 13.6 9.5Other 1.9 1.4Not stated 3.3 0.9Number 360 441

ANTE-NATAL CARE

Significant at 0.05 - * Significant at 0.01 - ** Significant at 0.001 - ***

Number Pre-intervention

Frequency (%)

Post-intervention

Frequency (%)

p-value

Once 33 (14.3%) 32 (12.1%) 0.12

Twice 31 (13.4%) 65 (24.5%) 0.02*

Three times 42 (18.2%) 57 (21.5%) 0.05*

Four times 119 (51.5%) 111 (41.9%) 0.04*

Not stated 6 (2.5%) - -

KNOWS ABOUT ATTENDING ANC 4+ TIMES

DISCUSSION

4th 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

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

Home 317(89.5%) 318(79.5 %) 0.04*

Away from home 15(4.2%) 10(2.5%) 0.12

Health facility 22(6.2%) 66(16.5%) 0.03*

Other/Not stated - 5(1.3%) -

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*

TBA 27(7.5%) 74(20.2%) 0.03*

Relatives/friends 142(39.4%) 168(46.0%) 0.06

Self 162(45.0%) 59(16.1%) 0.01**

Not stated 9(2.5%) - -

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.

CONCLUSION

Improvement in access to and utilization of the targeted

health care services:

Antenatal care: Significant impact

Skilled delivery: Significant impact

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

FURTHER RESEARCH RECOMMENDATION

Cost effectiveness study of the Ng'adakarin BAMOCHA model

ACKNOWLEDGEMENTS

European Commission

Big Lottery Fund

Turkana North and West sub Counties communities and Health Management Teams

THANK YOU