Center for Health Market Innovations (CHMI)

Programs

Private Nurse Midwives Networks in Kenya

last updated Oct 18, 2011

Overview

Implementing organization: 
Extending Service Delivery
Implementation Partner(s): 
IntraHealth, PATH and EngenderHealth
Year Launched: 
2001
Stage: 
Existing/expansion stage
Income Level of Target Population: 
Bottom 20%, 20-60% (lower to lower-middle)

Funding

Primary Source of Funding: 
Donor
Additional Source(s) of Funding: 
Donor, Membership/subscription fees
Funders: 
United States Agency for International Development (USAID)

Scale

Number of Facilities Operated/Networked: 
The Nyeri network of 12 clinics; The Nakuru network of 15 clinics
Summary: 

The Private Nurse Midwives networks are formally organized groups of private clinics and nursing homes operated by nurse midwives where a number of clinics and nursing homes operated by private nurse midwives are grouped together in a given locality for the purposes of facilitating peer support supervision for quality service provision.

Program goals/rationale: 

During the 1990s in Kenya, nurse midwives, a new group of private-sector service providers, were licensed to operate private clinics close to communities. Licensure to operate a private clinic requires at least ten years of service in a government or large private health care system to ensure supervision of professional experience and competencies in an effort to safeguard the communities from malpractice arising from lack of experience. The private nurse midwives operate private clinics, nursing and maternity homes primarily in densely populated peri-urban areas, rural trading centers and towns. The networks emerged out of the need for a sustainable supervision system and a continuing education program for the private nurse midwives.

The goal of the project is to improve access to quality PAC services by decentralizing this service to facilities closest to larger populations and private facilities operated by nurse midwives. Comprehensive postabortion care includes the following service elements:

  • Emergency treatment of abortion complications using Manual Vacuum Aspiration (MVA)

  • Postabortion family planning counseling and services

  • Linkage with other reproductive health services

  • Community involvement in postabortion care

  • Referrals for other services.

Key program components: 

These networks of health professionals contribute to an increase in the use of family planning services and have improved access to essential reproductive health services for women, including those seeking care for management of complications of abortion. Client records also indicate a decrease in the total number of clients needing postabortion care services. This suggests a positive impact of advocacy and educational campaigns and family planning services aimed at reducing unwanted pregnancies. The network system has been responsive to the needs of the population and private nurse midwives groups in a number of ways. First, members commit and utilize shared resources for the common good, and innovations have increased the clinics’ funds base. Second, continuing education has improved skills and service delivery to networks in different localities.

The use of a variety of practices and approaches described enabled the private nurse midwives to address their goals e.g Peer support supervision, in which the members consult one another in the management of complicated or challenging cases. The nurse midwives evaluate one another’s facilities using PAC set standards and provide feedback and recommendations for action and follow-up on the implementation of recommendations. In some networks, non-compliance is penalized; Continuing education for members through formal training programs organized and outsourced from the MOH and NGOs by the network system and Establishment of a fees system that combines sliding scale and payment in-kind renders their services affordable.

The results of the Private Nurse Midwives PAC pilot phase are encouraging because The Nursing Council of Kenya approved training of and PAC service delivery by nurse midwives in private practice; There is extensive community education on family planning and the dangers of unsafe abortion in the communities served by the private nurse midwives clinics and despite indicating that they did not have additional space in their clinics, 59 percent of the pilot group (including the Nakuru and Nyeri networks) created special MVA rooms that provided privacy, clean operation areas and restrooms for women after the operation. The space was created by either partitioning or reorganizing the clinic.

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