During the recent meeting in Nairobi on improving health systems through a maternal health framework, participants focused on knowledge gaps in the Kenyan health system that can negatively affect maternal healthcare. This focus on gaps sparked discussion around research needed (or not needed) in the maternal health field, supply gaps, and gaps between addressing technical, medical issues of maternal health (like preeclampsia or post partum hemorrhage) and larger society-wide gaps like gender equity. The gaps highlighted by participants at the Nairobi dialogue included:
- Gaps in knowledge: During the dialogue, members of the Kenyan maternal health community discussed the possibility of strengthening community health workers as an information delivery platform. Participants wondered about the possibility of using community health workers to distribute information both downward to the end user (patients), and then again to gather information from end users and distribute it upwards through the system to reflect the opinions of the direct users of the healthcare system.
- Supply gaps: Participants argued that while there is a large body of information in terms of maternal health supplies at the national level in Kenya, there is not as much data at different levels of the healthcare system. People working in the field noted that although there is supply information at the national level, there is not as much data on supplies at the actual health facility level where it is much needed and would be very helpful to successfully treat patients.
- Gaps in healthcare delivery: There is a strong need to address inequality in the distribution of health services as there are unequal services in rural and urban areas. Within those broad areas there may be further inequalities, as even in urban areas, slum areas or neighborhoods on the edges of cities may have less access to quality healthcare than populations that live in wealthier areas of the city or closer to the city center. Further there are broader questions of gender and access to care. Where women are not able to control household finances, they may be unable to access and pay for lifesaving care. Participants framed the question in a rights framework, “Do we value the lives of women less than men?”
- Health workforce gaps: There is a mismatch between the supply of health workers and the absorption of those trained health workers in Kenya. Many of them are not incentivized professionally or financially to stay in the system where they are trained. These health workers may leave for other countries or prefer to stay in urban areas depriving rural areas of a surplus of trained health workers.
- Gaps between words and actions: Several of the small working groups pointed to accountability as a serious issue, as there are gaps between the words of politicians on health issues and actual actions. The gap between the government promised funding for health and the actual lower amount of spending was consistently highlighted during the Nairobi dialogue as a serious gap in holding governments accountable for their promises.
As the groups summarized their action points and discussions, one major point of the larger group discussion was whether or not research can help address the gaps highlighted above. Most of the participants agreed that new research is not always beneficial. In fact, they argued that there is so much research on many of these gaps it would be more beneficial to study already existing research and to learn whether research outcomes have or have not been incorporated into the Kenyan health system. The lively conversation provoked by a broad discussion of gaps in the Kenyan health system provided a fertile ground to develop action points on maternal healthcare that participants then presented on the second day of the meeting to several Kenyan Members of Parliament. Ideally, this will be the first discussion of many as maternal health advocates, field workers, and researchers coalesce around ways to address the gaps in maternal healthcare.