This is the first in a blog series showcasing innovations and successes from the Kenya Boresha project – by Geofrey Tanui, David Githinji, Teresa Akun and Catherine Wamuyu from our team in Kenya.
In January this year, United Nations Secretary-General António Guterres called for global solidarity in the face of Covid-19. “Now is the time for unity and for the international community to work together in solidarity,” he stated.
It was a call to all global stakeholders to strengthen Sustainable Development Goal 17, a commitment to build global partnerships.
That's an approach Save the Children has always valued. We believe that we must come together – as different partners and in different ways – to solve the issues our world faces.
That includes global health challenges. To realise lasting improvements in the maternal and child health outcomes of the poorest communities, a global commitment to share resources, knowledge and technology is essential.
The rapid development of viable COVID-19 vaccines is one example of powerful strategic partnerships. We witnessed governments, civil society, research institutions and technical health experts working together to deliver a solution to today’s most immediate global health challenge.
So, what makes a good partnership?
Forming good partnerships is no easy feat. For one thing, all stakeholders involved must share a unifying vision and a belief that the diverse skills brought to the table are necessary in building that vision. Experts suggest good partnerships have 6 key components:
- recognising and accepting the need for partnership
- developing clear and realistic goals
- full commitment and ownership
- developing and maintaining trust
- creating robust and clear roles and responsibilities
- monitoring, measuring and learning.
The Save the Children–GSK partnership on maternal newborn health
Save the Children and GSK formed an ambitious global partnership in 2013 with the goal of using our combined expertise, resources and influence to help save 1 million children's lives. Spanning two phases – the first from 2013 to 2017 and the second phase beginning in 2018 and running to the end of 2022 – we have a shared vision of a world where no child under the age of five dies from preventable causes.
Our work has focused on strengthening health systems to increase access to and the quality of health and nutrition services by:
- investing in the training and reach of health workers in the most vulnerable communities
- researching and developing innovative methods to reduce infant and child deaths
- advocating at local and global levels for change
- helping children and people affected by humanitarian crises.
Since 2013, the partnership has reached more than 6 million people, including 3 million children.
Boresha project in Kenya
Save the Children and GSK have been working together in Bungoma county in western Kenya since 2014 and in Busia county since 2018. We support the Ministry of Heath to implement core maternal and newborn health services. Our joint aim is to help meet the health needs of mothers and babies and improve the quality of care they receive.
Our programme in Kenya is one example of a wider partnership that has leveraged the unique capabilities of GSK and Save the Children to deliver measurable impact – with the shared ambition of ending preventable deaths for all children under five.
The Boresha project has delivered a three-pronged approach to improve supply, demand and quality of maternal and newborn health services in Busia and Bongoma. Together, we have:
- trained health workers and improved infrastructure and essential equipment in health facilities
- provided supportive supervision and clinical mentorship of nurses and midwives to improve the quality of services
- advocated for the scale-up of specific interventions that reduce incidence of newborn mortality – kangaroo mother care and the use of chlorhexidine to prevent umbilical cord infection.
Neonatal sepsis: The magic of chlorhexidine
40,000 newborn babies in developing countries die from neonatal sepsis each year. This is a systemic bacterial infection that can be prevented with the application of a mild antibiotic, but which is most often not available to poor communities around the world. As a result, many newborn babies die from an easily preventable cause.
Save the Children and GSK decided together to reformulate chlorhexidine, an antiseptic commonly used in mouthwash, as a cream that can be easily applied to the umbilical cord after it has been cut. Save the Children then worked with the Kenya government and other health partners to draft the chlorhexidine policy and advocated for it to be scaled up nationally.
Although chlorhexidine was not part of routine care before the programme, the partnership successfully advocated for and supported the scale-up of chlorhexidine to 17 Kenyan counties by 2021, and for its inclusion in the national essential medicines list in Kenya.
Chlorhexidine has worked wonders for the prevention of umbilical cord infections that could have resulted in neonatal sepsis and death. Previously, most health facilities used surgical spirit on the cord to prevent infection. The guidelines then changed to urge health workers to use saline solution, then changed again to stop the use of any application on the cord.
Mothers were sent back home after they had had their babies, without any medicine to apply on the cord of their babies. Once they got home, mothers often applied wet soil, fresh cow dung, or even lizard poop, believing that they had healing properties. All these practices increased the risk of infection for the newborn babies.
Nancy (right) visits Emily, whose baby was treated with chlorhexidine.
Nancy Chepkwemoi, one of the 87 health workers trained in the use of chlorhexidine through the Boresha programme, explains the difference it’s making:
“Before we started using chlorhexidine, we received many cases of infections in newborn babies. Families spent a lot of money on treatment and in some cases some babies died.
“Save the Children’s support to Sambocho Health Centre has been very helpful. Most of us were not aware of chlorhexidine.”
By 2018, we had introduced chlorhexidine in all the health facilities we supported. We worked with county health officials in training health workers in how to use and dispense chlorhexidine. And we worked with the community to help them understand the dangers of some of the practices they used for cord care and supported them to transition to using chlorhexidine.
Mothers are no longer hesitant about using chlorhexidine. It’s now readily available at the facility level, thanks to the willingness of county governments to allocate resources to procure and stock it.
Conclusion
For the past 100 years, Save the Children has forged partnerships globally – with civil society, governments, global health institutions, influential health stakeholders, academics and private sector partners.
We believe that the cornerstone to effective, meaningful, and innovative development work, is cultivating relationships with partners who share our belief that every child has equal rights. That’s what decades of experience have taught us. And it’s why we’re committed to this approach.
Read the second post in this series on the Boresha project.
Photo at the top of the page shows a premature baby in Kenya being treated with antiseptic chlorhexidine cream to prevent infection (Ilan Godfrey/Save the Children).
