In Kenya today, nearly nine in ten women give birth in a health facility. This is progress worth recognising. It means that years of encouraging women to attend antenatal clinics, seek skilled care and deliver in health facilities have made a difference. Women have listened. Families have acted. Communities have changed.
Yet another statistic should stop us in our tracks: approximately 83 per cent of reported maternal deaths occur within health facilities.
Taken together, these figures reveal an uncomfortable truth. Women are doing what they have been advised to do, but reaching a health facility does not always guarantee that they will receive the timely, respectful and lifesaving care they need.
For years, much of our maternal-health messaging has focused on what women should do: attend antenatal clinics, recognise danger signs, save money, arrange transport and deliver in a health facility. These remain important. But when a woman arrives at a facility, responsibility must shift. The question can no longer be only, “Did she seek care in time?” We must also ask, “Was the facility ready for her?”
Was a skilled health worker available? Was she assessed promptly? Were essential medicines and blood products in stock? Was the theatre functional? Was an ambulance available if she needed a referral? Did the receiving facility have the capacity to treat her? Were warning signs recognised and acted upon or was precious time lost?
A mother should not survive childbirth because she was lucky enough to arrive during the right shift, at a facility with the right staff, working equipment and medicines in stock. Safe childbirth cannot depend on luck.
This is the moral urgency behind Every Woman Every Newborn Everywhere, or EWENE, a global movement to accelerate progress in maternal and newborn health. Kenya’s EWENE Acceleration Plan provides a critical opportunity to move from broad commitments to measurable action. It calls us to ensure that women and babies not only reach care but receive quality care when they get there.
Quality maternal healthcare requires functioning systems. It requires adequate and predictable financing, sufficient numbers of trained and supported health workers, essential medicines and commodities, reliable referral networks, functional equipment, and accurate data that is used to correct failures. It also requires dignity; no woman should be ignored, humiliated, discriminated against, or denied care because she cannot pay. Translating this into practice means three specific commitments.
First, county governments must ring-fence and disburse maternal health budgets on a predictable quarterly schedule, not release funds erratically at year-end when commodities are already out of stock. Second, the Ministry of Health’s ongoing shift to workload-based staffing, using the WISN (Workload Indicators of Staffing Need) methodology to overhaul national Staffing Norms and Standards, is the right reform.
It must now be finalised, funded and enforced at facility level with the same seriousness as any other public safety standard, backed by a public vacancy dashboard that communities and oversight bodies can actually see.
Third, every facility offering delivery services must meet a minimum equipping standard, blood products, oxytocics, a functional theatre, or a clear, resourced referral pathway to one, verified through routine, unannounced audits rather than self-reported checklists.
None of this is new thinking. It is the difference between a plan and a practice.
Recent disruptions in healthcare delivery, including the nurses’ strike, have reminded us how fragile the system can become when those who provide frontline care are overstretched, under-resourced or absent. Nurses, midwives and other healthcare workers carry enormous responsibility.
Accountability must therefore not become a search for individuals to blame. It must include ensuring that health workers have fair working conditions, adequate staffing, proper equipment and the support required to do their jobs well.
Accountability is not about attacking government or health facilities. It is about asking every responsible actor- national and county governments, health institutions, professional bodies, development partners, and communities to honour their commitments.
It means translating policies and budgets into care that women can experience. It means knowing where resources have gone, whether essential commodities are available, whether vacancies have been filled, and whether recommendations from maternal-death reviews have been implemented.
Every maternal death should be counted, reviewed, and answered with action. When the same preventable causes recur- haemorrhage, hypertension, sepsis, delayed referrals, or inadequate monitoring- we must be willing to ask what failed and what must change. A maternal-death review that produces no corrective action is merely a record of tragedy. Data should not sit in reports; it should save the next woman.
Communities must also have a meaningful place in this accountability process. Women and families are not passive beneficiaries of healthcare. They have the right to know what standard of care to expect, to report poor treatment without fear, and to participate in decisions about the services designed for them. Their lived experiences can reveal gaps that national averages often conceal.
Kenya has made important commitments to maternal and newborn survival. But commitments become credible only when they are financed, implemented, monitored, and felt at the point of care. Progress cannot be measured solely by the number of women entering health facilities. It must also be measured by how many leave those facilities alive, healthy, respected and holding healthy babies.
A woman who chooses to give birth in a health facility has fulfilled her part of the bargain. The facility and the system behind it must fulfil theirs. No mother should need luck to survive childbirth. She needs a health system that is ready, responsive, and accountable every single time.
