A pregnant woman does not always stop attending antenatal care because she does not value it. Sometimes, life simply gets in the way. The journey to the health facility may be long, household responsibilities may take priority, or she may feel well enough to wonder whether another visit is necessary. Yet a missed appointment can have consequences far beyond that single day.
In Garissa County, continuity of antenatal care remains a challenge. According to the 2022 Kenya Demographic and Health Survey (KDHS), only 31% of women who had a live birth attended four or more antenatal care visits, compared with 66% nationally.
At Iftin Level 4 Hospital, the focus is increasingly shifting from simply asking why a mother missed an appointment to finding practical ways to help her remain connected to care.
Through the Accelerate programme, funded by the Embassy of Denmark and implemented by Population Services Kenya (PS Kenya) and partners, community dialogues and strengthened linkages with Community Health Promoters (CHPs) are helping bring maternal health services closer to women in their communities. CHPs identify pregnant women, encourage them to start antenatal care early and link them to the facility. Their role does not end with the referral. They remind mothers about upcoming appointments, follow up with those who miss visits and provide information on pregnancy danger signs, birth preparedness and the importance of skilled delivery. They also support mothers to remain in care throughout pregnancy and complete the recommended eight ANC contacts.
This follow-up addresses some of the barriers that exist beyond the walls of the health facility. Before the intervention, distance, limited awareness, competing household responsibilities and inadequate follow-up contributed to missed ANC appointments. Health workers also faced challenges maintaining contact with pregnant women once they returned to their communities.
The CHP approach creates a stronger connection between the facility and the community. For a mother, this can mean having someone close to home who remembers when she is due back at the hospital, checks in when she misses an appointment and encourages her to seek care when she has concerns. For the health facility, it provides another way of identifying women who may require additional support and strengthens continuity between one ANC visit and the next.
To encourage continued follow-up, Iftin Level 4 Hospital provides a KES 200 motivation to CHPs for every pregnant woman they successfully link to ANC and follow up until completion of the recommended eight ANC contacts. The motivation has encouraged CHPs to take greater ownership of maternal health activities within their communities. Instead of simply referring pregnant women to the hospital, they are taking a more active role in identifying mothers, linking them to services and following up throughout pregnancy.
This is where the partnership with Accelerate and PS Kenya becomes important. While the hospital provides the CHP motivation, Accelerate supports the community dialogue and linkage component, helping strengthen the relationship between the community and the facility. Together, these efforts are helping shift antenatal care from a series of individual clinic visits to a continuous journey of care.
A referral is no longer simply a direction to the hospital. It becomes the beginning of an ongoing relationship between a mother, her Community Health Promoter and the health system.
That relationship is particularly important in advancing efforts towards zero preventable maternal deaths, one of the three ICPD+25 commitments that the Accelerate programme contributes to, alongside zero unmet need for contraception and zero gender-based violence and harmful practices.
Funded by the Embassy of Denmark, Accelerate works to strengthen sexual and reproductive health and rights and address gender-based violence in underserved communities. Through PS Kenya and its partners, the programme strengthens systems and community structures that help people access and remain connected to essential services.
At Iftin, this work is taking place at the point where the health system meets everyday life. A CHP may be the person who notices when a pregnant woman has not returned for her next appointment. A conversation may remind her why continued ANC attendance matters. Information on danger signs may help her recognise when she needs urgent care. Continued follow-up may help her remain connected to services throughout pregnancy.
These may appear to be simple actions, but together they address an important gap in maternal healthcare: what happens after a woman leaves the health facility.
The experience at Iftin also demonstrates that strengthening maternal health does not always require creating an entirely new system. Sometimes, it means strengthening the connections between the systems and people that already exist. Health workers provide care at the facility, while CHPs extend that connection into the community, helping mothers navigate the space between one appointment and the next.
The next step will be to strengthen monitoring of CHP referrals and ANC attendance and identify mothers who drop out before completing the eight recommended contacts. Continued supervision and collaboration between CHPs and the hospital will also be important in sustaining the approach and reaching more pregnant women.
For PS Kenya, strengthening this community-facility linkage is part of a broader effort to ensure that women and girls can access quality sexual and reproductive health services and remain connected to the care they need. At Iftin, that ambition is becoming something tangible: a stronger safety net around a pregnant woman throughout her journey of care.
Because sometimes, protecting a mother’s journey towards a safe pregnancy begins with something simple: when she does not return, someone notices, someone reaches out, and someone helps her reconnect with care.