A Quarterly Snapshot of Scale and Impact: Jacaranda's Q1 Impact Report Jan-March 2023
Changing the Forecast for 2030
In February, the UN launched its Global Estimates of Maternal Mortality report for 2010-2020, presenting both a sobering view of the past decade and a grave forecast for SDG 2030 targets. Jacaranda commit to breaking this cycle by scaling solutions that not only work to improve quality in the here and now, but embed within government health agendas and budgets in the long-term. The work you’ll read about in their Q1 Impact Report speaks to this - from expanding a data-driven approach to ensure respectful maternity care, to defining ‘exemplars for quality’ in hospitals and health systems, and making deep user-centered research the foundation of program design.
AMPLIFYING MOTHER’S VOICES: A data-driven approach to ensuring respectful care for mothers. If women find themselves mistreated, they have two options: seek health services elsewhere or don’t seek care at all. Respectful care is paramount to timely, quality care, but in Kenya, few formal channels exist for mothers to share feedback. Each month, mothers receive an SMS from Jacaranda's digital health tool PROMPTS asking them to share whether they were treated with respect during their facility visits. They are asked to explain instances of disrespectful care, helping pinpoint the often-invisible issues hindering care provision. In Q1, they rolled out new Quality of Care dashboards, consolidating data from millions of mothers’ experiences with data from facilities to help nurses and their managers rapidly identify the drivers of poor quality care - from skills gaps and stock-outs to disrespectful care. Traffic light coding helps easily and routinely identify gaps, from issues of privacy, poor communication or confidentiality breaches, to instances where care is refused or held back. Over the coming months, they will closely monitor uptake and use of these dashboards among their government partners - with the hope that ‘client-side’ data becomes a driving factor in ensuring all mothers receive dignified care during and after pregnancy.
Data dashboards for dignified care. – When the in-charge at a Nairobibased facility noticed reports of mothers being turned away from prenatal care, she called an urgent meeting. It was quickly apparent that while her colleagues were keen to offer services to all mothers in the waiting room, poor scheduling, heavy workloads, and patients turning up outside hours meant it wasn’t always possible. New measures have since transformed their capacity to offer services, including time management training, streamlined service delivery across, posters in the waiting areas indicating service times, and new ticketing systems.
EXEMPLARS FOR QUALITY: How rethinking Kakamega’s hospitals and health systems could define new standards of care for the future. H.E. Hon. FCPA Fernandes Barasa, OGW Governor of Kakamega County, Chairperson Finance, Planning and Economic Affairs Committee (CoG) recently announced 'My intention and that of our partners is to redesign how we offer health services to ensure that expectant mothers and other members of our community access facilities with competent medical personnel and appropriate equipment as quickly as possible',
Poor quality care is a complex, cross-sectional issue, but too often its drivers are dealt with in silos. In March, Jacaranda representatives joined Kakamega’s Governor and County Health Management teams to launch Tutunze Kakamega, a crosssectoral strategy that tests how to improve maternal and newborn survival by shifting where and when mothers access care. Since 2019, Jacaranda and a coalition of local partners have supported Kakamega’s government to expand the capacity of delivery services in hospitals while improving the quality of antenatal and postnatal care in clinics. Malava Sub-County Hospital is the first of a number of Kakamega’s hospitals to welcome an increased volume of deliveries in line with the shift. Its capacity will be routinely assessed against new ‘Facility Readiness’ standards, which take into account a range of factors influencing services - financing, staff, equipment, beds and medicines - to consistently ensure the best possible outcomes in even the most complex of cases.
Behind every safe delivery is a set of co-dependent drivers that ensure mothers get timely, quality care. Between October 2022 and February 2023, we saw notable improvements at Malava Sub-County Hospital. 1 new maternity wing, with an equipped delivery room, maternity & newborn units. 21% increase in staffing, including new pediatricians and anesthetists. 57% increase in available essential commodities for mothers and babies.
A DEEPER DIVE How research is helping us to unearth answers to the critical questions facing mothers and babies today.
Research is the backbone of design. It ensures Jacaranda's innovations continue to reach the evolving needs of those they serve, and serve as sustainable solutions to the pressing issues facing mothers in government health systems. Their research capacity continues to grow, in Q1, otheir Research, Design & Evaluation team, including data analysts, field researchers, and biostatisticians, reached double figures. The same quarter saw the completion of data collection and preliminary analysis of a large-scale Randomized Control Trial, led by independent evaluators at Harvard University, with data collection completed by IPA, to generate deeper, cross-cutting insights into the impact of their programs. They also forged new research partnerships to answer some of the critical questions in maternal and newborn health today.
DATA SNAPSHOT Putting mothers in the driving seat of defining and reporting on technical quality.
The thousands of daily interactions we have with mothers on PROMPTS helps inform the clinical quality of prenatal care. Prenatal check-ups help ready women for birth and spot early signs of complications but, across Kenya, their quality varies by facility. After each check-up, mothers are asked whether the appropriate clinical steps were taken using a simple ‘yes/no’ SMS format. ‘Was your blood pressure taken?’, ‘Did you discuss labor signs?’, This feedback helps health system managers track and standardize the clinical quality of prenatal care across the facilities they manage, and dig into issues, from informational gaps (eg. birth plan), to systemic gaps like medicine stock-outs or equipment shortages. It also gives mothers the confidence to demand the right care. A nurse incharge recently remarked to a member of our field team that their clients now actively request certain services - during their prenatal care visits as a result of PROMPTS messages.
EMBRACING #DigitALL FOR INTERNATIONAL WOMEN'S DAY
On March 8th, Jacaranda joined the world in celebrating digital equity, the theme for this year’s International Women’s Day. The theme felt acutely relevant to the work they’re doing now; exploring participatory approaches to digital design, testing alternative means to reach ‘last mile’ mums through PROMPTS, and translating women’s voices into actionable data for governments. Jacaranda's 2025 Strategy looks to make inclusive digital tools a driving force behind better maternal and newborn health outcomes - empowering women to confidently navigate the health system and fortifying the frontline health workforce to ensure they receive quality, dignified care.