Endline Evaluation of 'Kenya Midwives Innovative and Sustainable Solutions for Education and Employment (KISSMEE) Entrepreneurship Project' in Kisii and Kajiado Counties

Background:

Amref International University had conducted a pilot of the Kenya Midwives Innovative and Sustainable Solutions for Education and Employment (KISSMEE) Entrepreneurship Project, over a three-year period in Kisii and Kajiado Counties. The project was embedded in a low- to middle-income country (Kenya) where 65% of women have access to skilled birth attendants. Further, health facilities experienced a shortage of midwives (2.3 midwives per 10,000 people) because the government lacked the finances to employ the 3,000 comprehensive midwives who graduate annually from tertiary institutions. The project offered midwives additional training in newborn and child nutrition for the first 1,000 days, applied maternal, newborn and child health (MNCH) practices, and business and entrepreneurship skills (Kosgei, Ngunju, Matiang’i, Omari, and Mukami, 2020). To ensure no further shortage by taking midwives away for training, the project leveraged on technology. Training was done through mobile and e-Learning delivery formats, enabling the midwives to build their skills even as they continued to offer care in their respective health facilities. The mothers/clients paid a small fee to receive services at their homes. Through these activities, the project would improve the socio-economic status of midwives while positively impacting the health indicators of mothers and children in the pilot sites.

Objectives:

The main aim of conducting this end term evaluation was to determine the extent to which the program had met the expected results. The end term evaluation was based on the specific objectives of the project which included:
i. To assess the extent to which project midwives acquired the desired competencies
ii. To determine the project’s impact on livelihoods of midwives in the project
iii. To determine the project’s impact on pregnant women’s health outcomes
iv. To determine the project’s scalability and sustainability

Study design:

This study applied a cross sectional design utilizing mixed methods of data collection. The target population of the study was 257 KISSMEE trained midwives and 164 mothers who had benefited from the project under the Tunza Mama Programme. All trained midwives and mothers were targeted to participate in filling the midwives survey questionnaire and mothers survey questionnaire respectively. For the midwives’ survey, 112 midwives responded to the survey questionnaire representing a response rate of 43.6%; while for the mothers’ survey, 21 mothers responded to the survey questionnaire representing a response rate of 12.8%. The midwives and mothers survey tools were designed in KoboCollect™ e-forms to facilitate automated data capture. The electronic form link was circulated to the midwives and mothers (who benefited from the program) to fill-in the data electronically and remotely. Telephone interviews were done for the mothers who could not fill the questionnaire on their own using the KoboCollect e-forms or lacked access to a smartphone. The database with details ie. telephone contacts or emails and county of residence, of all trained midwives and mothers who had benefited from the project was provided by the project manager to facilitate sharing the KoboCollect™ e-forms or the telephone interviews. Qualitative data was collected usingsemi-structured key informant guides for the sub county health management teams (SCHMTs) and project officers. Quantitative data was analyzed using Statistical Package for Social Sciences (SPSS v.26). Descriptive statistics and cross-tabulations were the principal data analysis techniques. Qualitative data was thematically analyzed using Nvivo 12.

Key findings: