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Mother accessing ANC service in Nairobi, Kenya.
Both civil society organisations (CSOs) and media play an important accountability function. Their strengths complement each other. For example, while CSOs often work more closely with communities on issues they face on the ground, the media plays a powerful role in raising public awareness on these issues to a broader audience, and therefore key decision-makers. During COVID-19 the E4A-MamaYe project brought civil society and media together to enable stronger advocacy in response to a significant problem: many mothers and children were unable or afraid of accessing essential health services.
The pandemic’s impact on essential health services
COVID-19 shocked Kenya’s health system. Many sub-national governments are struggling to continue to provide quality health services for their citizens. The disruption in health service provision is mainly caused by a shortage of health workers, equipment - including personal protective equipment (PPE), testing kits, laboratory facilities and at times drugs.
These shortages contributed to the closure of a few facilities that offer critical health services in Nairobi city county between the period of March and September 2020. The lack of PPE exposed many healthcare workers and health facility staff to the virus and discontinuity of service provision was considered the immediate action to protect the patients coming in-mostly expectant mothers. Among those affected was the Kibera South Health Centre, Pumwani Maternity Hospital, Ngara Health Centre and Westlands Health Centre.
During the pandemic, CSOs recorded cases of women who had home deliveries without skilled birth attendants and of pregnant women and girls avoided seeking antenatal care services. This was because Kenya’s night curfew created a barrier to essential services for expectant women and girls at night. Most of them feared arrest or police harassment to them or people accompanying them. Some also cited fear of contracting the virus in health facilities after reading the news stories about the lack of protective equipment in health facilities which is essential to make sure health workers can provide safe services.
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Nurse at a Nairobi private clinic attending to a mother -
Nurse at a Nairobi private clinic attending to a mother -
Mother waiting to access care at a private facility
Working together to hold the government to account
CSOs leveraged their strong community relationships and empowered women to share their fears around accessing maternal and new-born health (MNH) services with the media. Community health volunteers spoke out about having to continue to visit mothers in their homes without protective equipment. CSOs subsequently developed advocacy messages that were backed up by powerful stories from affected women and community health volunteers, which targeted key MNH decision-makers and featured in both print and digital media.
The media also interviewed CSOs, who called on decision-makers to provide healthcare workers with adequate protective equipment to slow down infection rates and restore trust among mothers that they can safely access health services. They also urged the government to support community health volunteers with PPE as they are important frontline workers who refer mothers to health facilities.
Media outlets also used the national Ministry of Health’s daily press conference on the government’s pandemic response to address the disruption of MNH services and closure of health facilities in Nairobi city county. In its response, the government responded that facilities were closed to protect women and to stop the spread of the virus, as highlighted in their reproductive, maternal, new-born, child and adolescent health (RMNCAH) COVID-19 guidelines. The government subsequently provided an update on plans to re-open Kibera South Health Centre, reassuring the broader public that staff would be provided with PPE and that key safety protocols would be followed. This was a significant advocacy result for CSOs as the media spotlight on these issues had mounted enough public pressure to urge the government to act.
The pandemic shifted the government’s focus on emergency response measures, at the expense of providing other essential health services such as MNH, which risked reversing decades of progress made in sexual and reproductive health. The collaboration between CSOs and the media to hold the government to account during the pandemic provides a powerful example of how the two can work together to save lives.