Improving iron and folate supplement availability for Antenatal Care in Kenya
Realizing the importance of Antenatal Care (ANC) Services in improving maternal and child health, the Kenya Ministry of Health and the USAID Health Care Improvement Project (implemented by University Research Co. LLC) initiated an activity to improve the quality of antenatal care in Kenya. In agreement with other stakeholders, we decided to launch this activity in a rural district which was performing below the national average in the utilization of ANC/Preventing Mother-to-Child Transmission (PMTCT) of HIV services and was relatively easy to access. Based on these broad criteria, Kwale (Matuga) district was selected as the pilot district for this activity.
The USAID Health Care Improvement (HCI) Project initiated discussions with local officials of the Kenya National Medical Supples Agency (KEMSA) to understand why the supplies of these essential drugs had stopped for nearly two years. During discussions with KEMSA, it was understood that there was a procurement problem at the national level. The national drug supply agent had decided to stop procurement of single iron sulfate and folate tablets and had opted for a combined formulation. However, no supplier responded to the tender for the combined formulation, this resulted in an acute shortage of hematinics in the national supply. Upon learning about this bottleneck, HCI initiated dialogue with both the national supply agency and the departmental heads in charge of essential drugs and commodities supply at the Ministry of Health and advocated for resolution of this issue. As a result of the ensuing dialogue, the issue of shortage in hematinics supply was highlighted at national level. However, it was also clear that it would take about a year or more for the national supply to resume.
This case report has a limited sample size and generalizability, but it showcases the importance of working across all levels of the system and the use of data for decision making at all levels. Quality improvement activities are often hampered by challenges of irregular supplies. It is hoped that this case study will provide impetus to quality improvement activities to surmount some of the challenges of supplies and equipment by applying the same methodologies they use to improve compliance with service delivery standards.