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21st November 2016 - Circulation 013
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pital deliveries; so far, despite an increase of 364 deliveries in
2016, the sub-County hospital boasts of zero mortality.
“Early preparation through birth plan ensures a mother
chooses the facility for delivery, identifies their birth
companion, and is kept reminded of the due date,” ex-
plained Mercy Kitonyi.
“We believe that this approach has been an avenue to
building a harmonized relationship between community
and the facility. Women reached with birth preparations
information and deliver at the facility get back home
with news of dignified quality care. This makes me proud
to serve,” she added.
The uneven geography presents a dusty, hot and humid semi-
desert, which does not allow easy mobility for expectant moth-
With a target of 38 deliveries per month, Kauwi sub-County
Hospital recorded an average of 16 from 2012 to 2015; 22
potential safe services were unaccounted for – failing in her
mission to ‘promote and participate in provision of quality,
affordable, accessible health services to all Kenyans.’ Despite
the strained human resources for health at the facility, it was
assumed that with over 260 annual home deliveries, the la-
boratory, clinical, pharmaceutical and nursing services associ-
ated with the maternity unit were underutilized. However,
starting January 2016, through her visionary Work Improve-
ment Team (WIT), she has realized a 143% increase in hospi-
tal delivery.
Led by Mercy Kitonyi (Medical Officer) and Isabella Mati
(Nursing Officer) who has served for 1.3 and 4 years respec-
tively at the facility, the duo has managed to have every health
worker’s assignment gravitate around improvement aims; in-
crease skilled delivery. With a team of 9 nurses, each member
is assigned a specific area such as Ante-Natal Care (ANC), Post-
Partum Family Planning (PPFP) and Child Welfare Clinic (CWC);
monthly WIT meeting facilitates reviews and planning through
identification of gaps and development of strategies.
Working with the premise that expectant women did not know
the benefits of hospital delivery, the WIT engaged Community
Health Workers (CHWs) to identify and track candidates for
skilled deliveries to ensure they aptly start and complete all
ANC visits. Having been attracted to the social marketing pack-
age presented by CHWs, which included access and utilization
of CWC services, all expectant mother were taken through
benefits of hospital delivery at every ANC visit.
Bearing in mind the hospital’s bed capacity, Kauwi ensured
birth plans were prepared by each candidate as a means of
increasing acceptance to and reducing mortalities during hos-
700 plus
...expected deliveries in 2017
Increasing Skilled Delivery at Kauwi:
Tact for Uneven Landscape
About Kauwi sub-County Hospital
 Kauwi - a level-four facility in Kitui West sub-County -
serves a catchment population of 12,038, and has an
annual proportion of 3.84% deliveries which translates
to 462.
 The hospital offers promotive, preventive, rehabilitative,
curative, maternal and referral services on a 24 hour
basis – with a bed capacity of 17 and an active CCC.
 It is managed by a medical officer, hospital administra-
tive officer, nurses, clinical officers, lab technician,
pharm tech, PITC counsellors, supportive staff, HRIO,
nutritionist, and volunteers.

2. The views in this publication do not necessarily reflect the opinion and position of URC, USAID, or the MoH. For queries, comments and any other form of feedback, kindly communicate directly to bokaka@urc-chs.com
ers. Upon arrival at the facility, despite the fact that
one could still be a day-or-two from delivery and in
spite the odds for space at the facility, shelter with
accommodating food and beddings are provided to
ensure retention of mothers for safe delivery.
“We have mothers who now know the benefits
of delivering at the facility. However, their de-
termination and intent can be diverted to a
traditional birth attendant due to vast cover-
age they have to make on foot, only to be told
they are not ready. Making a shelter for them
is a score idea for WIT,” narrated Isabella Mati.
Reported in many client exit interviews, it is global
knowledge that health workers attitude has deterred
many from accessing health care at public facilities.
Part of Kauwi’s WIT assignment delved into finding out
causes and possible solutions to improving service pro-
vider attitude.
Six months into operation, critical has been the contin-
uous medical education that optimistically reassures
health providers to undertaking delivery preparatory
assignments and procedures, attaining improved deliv-
ery skills through practice, and engaging with mothers
Written by: Bill Okaka (Knowledge Management and Com-
munication Officer) Contributors: Gladys Mutinda (QI Advi-
sor) and Peter Mutanda (Senior QI Advisor).
Dr Mercy Kitonyi (seated right) and a section of the Work Improvement Team
reviewing maternity data. Photo by: P. B. Okaka.
WIT formed and
duties assigned to
track indicators
CHWs track ex-
pectant mothers
Health education
on individual birth
plan provided
Provision of mater-
nal shelter
in friendly manner; leading to positive outcomes.
As Kauwi expects 700 plus deliveries in 2017, through the WIT she plans
to host a maternity with a new born unit and a theatre to fulfil her vi-
sion of being ‘an effective hospital system’ - leading by example. ##